The incidence of myocardial injury following post-operative Goal Directed Therapy

Pearse, Rupert M; Dawson, Deborah; Fawcett, Jayne; Rhodes, Andrew; Grounds, R. M.; Bennett, David

doi:10.1186/1471-2261-7-10

Cited by 13 publications

(8 citation statements)

References 18 publications

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“…This may relate to harmful effects, in particular myocardial ischaemia, when inotropic therapy is administered in high doses. However, more recent GDHT protocols, using only low-dose inotropic therapy, do not appear to be associated with myocardial ischaemia [50]. The importance of the dose of inotropic agents has also been highlighted by the findings of a recent metaregression analysis of five published clinical trials of perioperative dopexamine infusion.…”

Section: Perioperative Goal-directed Haemodynamic Therapymentioning

confidence: 95%

The use of early intervention to prevent postoperative complications

Jhanji

Pearse

2009

Current Opinion in Critical Care

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Section: Perioperative Goal-directed Haemodynamic Therapymentioning

confidence: 95%

The use of early intervention to prevent postoperative complications

Jhanji

Pearse

2009

Current Opinion in Critical Care

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“…In a meta-analysis (8), the use of inotropes in combination with fluids reduced the mortality (OR 0.47, 95% CI 0.29-0.76), and was superior to those studies with only with fluids. Similarly, Pearse et al (95) showed that the pre-emptive use of inotropes in the postoperative management was not associated with an increase of myocardial injury, and as mentioned above, another recent meta-analysis (11) showed that the therapy with fluids and inotropes in high-risk surgical patients was not associated with an increased risk of cardiac complications.…”

Section: Inotropesmentioning

confidence: 94%

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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“…Interestingly, in the modern era of advanced cardiologic diagnosis and intervention for acute MI, the cause of in-hospital death has shifted from cardiovascular to noncardiovascular [60]. Indeed, several contemporary studies in the nonvascular, noncardiac surgical population demonstrate a significant disconnect between the high rates of cardiac ischemic morbidity seen in the vascular surgical population and far lower rates in other surgical subspecialties [61]. An important shift in emphasis has recently targeted cardiac insufficiency, the prevalence of which continues to rise.…”

Section: Emergence Of Cardiac Insufficiency Rather Than Cardiac Ischementioning

confidence: 97%

Defining higher-risk surgery

Ackland

Edwards

2010

Current Opinion in Critical Care

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Higher risk surgical patients present an increasingly major challenge for healthcare resource utilization. Detailed outcome studies using validated morbidity tools are urgently required to establish the extent to which postoperative morbidity may be predicted. Robust identification of patients at the highest risk of perioperative morbidity may permit further clinic-to-bench translational understanding of the pathophysiologic mechanisms underlying postoperative organ dysfunction. Defining the high-risk surgical patient population is as critically important for global public health planning as it is for the perioperative team.

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The incidence of myocardial injury following post-operative Goal Directed Therapy

Abstract: Background: Studies suggest that Goal Directed Therapy (GDT) results in improved outcome following major surgery. However, there is concern that pre-emptive use of inotropic therapy may lead to an increased incidence of myocardial ischaemia and infarction.

Cited by 13 publications

References 18 publications

The use of early intervention to prevent postoperative complications

The use of early intervention to prevent postoperative complications

Perioperative Haemodynamic Optimisation

Defining higher-risk surgery

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