Early Goal-Directed Therapy

Early Goal-Directed Therapy



Basic Information image



Overview and Goal(s)




• Early goal-directed therapy is hemodynamic optimization through the use of resuscitation endpoints to guide therapy and improve tissue oxygenation in an effort to reduce mortality.


• Involves a three part strategy:


image Maintain preload: The circulating fluid volume

image Maintain afterload: The systemic peripheral resistance

image Maintain cardiac contractility


Indications




• Severe injury, trauma, or septic disease where tissue oxygen delivery is reduced or variable, cell oxygen uptake is dysfunctional, or myocardial depression is present


• Parameters monitored to identify patients at risk, their prognosis and ideal therapy required are:


image Central venous pressure (CVP)

image Mean arterial pressure (MAP)

image Lactate and pH

image Central or mixed venous oxygen saturation


Contraindications




• Each factor alone cannot be used to predict prognosis.


• Lactate, especially, can be affected by cellular dysfunction as well as perfusion, and serial measurements should be taken into consideration for all predictions.


• Excessive resuscitation (to hyperphysiologic levels) is likely not beneficial.


• Monitor heart rate and rhythm if vasoactive agents are used.

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Jul 24, 2016 | Posted by in SMALL ANIMAL | Comments Off on Early Goal-Directed Therapy

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