Effects of maximizing oxygen delivery on morbidity and mortality in high-risk surgical patients

Lobo, Suzana Margareth; Salgado, Paula F.; Castillo, Vania G. T.; Borim, Aldenis Albaneze; Polachini, Carlos A.; Palchetti, José C.; Brienzi, Sergio L. A.; Oliveira, Gabriel Stephani de

doi:10.1097/00003246-200010000-00003

Cited by 230 publications

(143 citation statements)

References 48 publications

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“…27,[34][35][36] However, other clinical trials have reported favorable outcomes with supranormal oxygen delivery. [37][38][39] An optimal approach may be early goal-directed therapy, which has been shown to reduce mortality for patients with severe sepsis and septic shock. 40 This approach involves adjustments of cardiac preload, afterload, and contractility to balance oxygen delivery with V O 2 .…”

Section: Oxygen Deliverymentioning

confidence: 99%

Cardiorespiratory Interactions: The Relationship Between Mechanical Ventilation and Hemodynamics

Cheifetz

2014

Respir Care

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The overall goal of the cardiorespiratory system is to provide the organs and tissues of the body with an adequate supply of oxygen in relation to oxygen consumption. An understanding of the complex physiologic interactions between the respiratory and cardiac systems is essential to optimal patient management. Alterations in intrathoracic pressure are transmitted to the heart and lungs and can dramatically alter cardiovascular performance, with significant differences existing between the physiologic response of the right and left ventricles to changes in intrathoracic pressure. In terms of cardiorespiratory interactions, the clinician should titrate the mean airway pressure to optimize the balance between mean lung volume (ie, arterial oxygenation) and ventricular function (ie, global cardiac output), minimize pulmonary vascular resistance, and routinely monitor cardiorespiratory parameters closely. Oxygen delivery to all organs and tissues of the body should be optimized, but not necessarily maximized. The heart and lungs are, obviously, connected anatomically but also physiologically in a complex relationship.

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Section: Oxygen Deliverymentioning

confidence: 99%

Cardiorespiratory Interactions: The Relationship Between Mechanical Ventilation and Hemodynamics

Cheifetz

2014

Respir Care

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“…So it seems reasonable to think that manipulating haemodynamics in some patients with pharmacologic agents (fluids and inotropes) to reach predefined goals may expose them to unnecessary risks. In the study reported by Lobo et al (27) 58% of the protocol group patients did not achieve the predefined goals despite the high doses of dobutamine (19±12 mcg kg -1 min -1 vs. 10±5 mcg kg -1 min -1 in achievers) and more fluid (median value 6.5 vs. 4 L). Interestingly, in a recent meta-analysis (11) EGDT with fluids and inotropes in high-risk surgical patients was not associated with an increased risk of cardiac complications, and actually the benefit was most pronounced in patients receiving fluids and inotropes with the use of minimally invasive cardiac output monitors.…”

Section: When or Where To Stop?mentioning

confidence: 89%

Perioperative Haemodynamic Optimisation

Aya¹,

Cecconi²,

Rhodes³

2014

Turk J Anesth Reanim

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56During the latest years, a number of studies have confirmed the benefits of perioperative haemodynamic optimisation on surgical mortality and postoperative complication rate. This process requires the use of advanced haemodynamic monitoring with the purpose of guiding therapies to reach predefined goals. This review aim to present recent evidence on perioperative goal directed therapy (GDT), with an emphasis in some aspects that may merit further investigation. In order to maximise the benefits on outcomes, GDT must be implemented as early as possible; intravascular volume optimisation should be in accordance with the response of the preload-reserve, goals should be individualised and adequacy of the intervention must be also assessed; non-invasive or minimally invasive monitoring should be used and, finally, side effects of every therapy should be taken into account in order to avoid undesired complications. New drugs and technologies, particularly those exploring the venous side of the circulation, may improve in the future the effectiveness and facilitate the implementation of this group of therapeutic interventions.

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“…There have been several prospective randomised peri-operative optimisation studies demonstrating a significantly lower mortality in the intervention group compared to controls [11,13,[23][24][25]. The intervention increased oxygen delivery in a variety of ways.…”

mentioning

confidence: 99%

Are we operating as well as we can? Critical care to minimise postoperative mortality and morbidity

Goldhill¹,

Down²

2008

Anaesthesia

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Effects of maximizing oxygen delivery on morbidity and mortality in high-risk surgical patients

Abstract: Older patients with existing cardiorespiratory illness undergoing major surgery have a reduced morbidity and mortality when dobutamine is used to maximize oxygen transport.

Cited by 230 publications

References 48 publications

Cardiorespiratory Interactions: The Relationship Between Mechanical Ventilation and Hemodynamics

Cardiorespiratory Interactions: The Relationship Between Mechanical Ventilation and Hemodynamics

Perioperative Haemodynamic Optimisation

Are we operating as well as we can? Critical care to minimise postoperative mortality and morbidity

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