Review

Clinical review: Goal-directed therapy in high risk surgical patients

Nicholas Lees, Mark Hamilton and Andrew Rhodes^*

• * Corresponding author: Andrew Rhodes andyr@sgul.ac.uk

Author Affiliations

Department of Intensive Care Medicine, St George's Healthcare NHS Trust, Blackshaw Road, London SW17 0QT, UK

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Critical Care 2009, 13:231 doi:10.1186/cc8039

Published: 26 October 2009

Abstract

A small group of patients account for the majority of peri-operative morbidity and mortality. These 'high-risk' patients have a poor outcome due to their inability to meet the oxygen transport demands imposed on them by the nature of the surgical response during the peri-operative period. It has been shown that by targeting specific haemodynamic and oxygen transport goals at any point during the peri-operative period, the outcomes of these patients can be improved. This goal directed therapy includes the use of fluid loading and inotropes, in order to optimize the preload, contractility and afterload of the heart whilst maintaining an adequate coronary perfusion pressure. Despite the benefits seen, it remains a challenge to implement this management due to difficulties in identifying these patients, scepticism and lack of critical care resources.