Can we standardise treatment?
In 1988 Shoemaker developed the first principles of goal directed therapy (GDT) and reported on its superiority regarding outcome.
This concept has been adopted ever since and new perioperative indications such as general, abdominal, cardiac and orthopaedic surgery have evolved. Improved outcome through GDT has been proven in many publications.
Algorithms or standard operating procedures (SOP) have become more
and more important in the daily business of physicians and nurses worldwide. They are the key tools to translate the concept of GDT into clinical practice.
GDT in Abdominal Surgery: The Salzwedel Study
Just by using Cardiac Index (CI), Pulse Pressure Variation (PPV) and Mean Arterial Pressure (MAP) as target parameters combined in a smart algorithm, Salzwedel et al. were able to reduce complications significantly. A standard radial artery, a high resolution pressure transducer (ProAQT), a monitoring system (PulsioFlex) and a plan how to manage your patient (Algorithm) is all you need to succeed.
GDT in Cardiac Surgery: The Goepfert Study
Just by using Global Enddiastolic Index (GEDI), Stroke Volume Variation (SVV), Mean Arterial Pressure (MAP) and Heart Rate (HR) as target parameters combined in a smart algorithm, Goepfert et al. were able to reduce complications and length of ICU stay in cardiac surgery patients significantly. A transpulmonary thermodulution catheter (PiCCO), a standard pressure transducer, a monitoring system (PulsioFlex) and a plan how to manage your patient (Algorithm) is all you need to succeed.
1. Shoemaker WC et al., Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest 1988; 94(6): 1176-86.
2. Goepfert M et al., Individually Optimised Haemodynamic Therapy Reduces Complications and Length of Stay in the Intensive Care Unit - A Prospective, Randomised Controlled Trial. Anesthesiology 2013; 119(4): 824-836.
3. Salzwedel C et al., Perioperative goal-directed hemodynamic therapy based on radial arterial pulse pressure variation and continuous cardiac index trending reduces postoperative complications after major abdominal surgery: a multi-center, prospective, randomized study. Crit Care 2013; 17(5): R191.