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Báo cáo y học: " Improving surgical outcomes: it is the destination not the journey"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Improving surgical outcomes: it is the destination not the journey. | Wilson and Davies Critical Care 2010 14 177 http ccforum.eom content 14 4 177 CRITICAL CARE COMMENTARY L__ Improving surgical outcomes it is the destination not the journey Jonathan Wilson and Simon Davies See related research by Benes etal. http ccforum.eom content 14 3 R118 Abstract Studies have demonstrated that optimising the circulating volume reduces morbidity after major surgery. This optimisation is usually achieved through maximisation of the stroke volume guided by oesophageal Doppler. New monitoring parameters of preload responsiveness using information from the arterial trace are now showing some promise in achieving the same goal. The present commentary examines these new parameters with respect to improving outcomes for the high-risk surgical patient. In the previous issue of Critical Care Benes and colleagues have demonstrated improvements in outcomes for patients undergoing major intra-abdominal gastrointestinal or vascular surgery by giving additional fluid boluses in order to maintain a variation in stroke volume SVV 10 rather than targeting the stroke volume itself 1 . Targeting elevated oxygen delivery or stroke volume improves outcome after high-risk surgery 2 3 . Protocols used in these studies have required either pulmonary artery catheterisation or the insertion of an oesophageal Doppler monitoring ODM probe. The pulmonary artery catheter is highly invasive whilst the use of ODM is restricted to the anaesthetised or heavily sedated patient. Despite these limitations ODM is considered a minimum standard of care for high-risk surgical patients 4 . In many respects Benes group s findings echo those of ODM optimisation studies in as much as the intervention group received 400 ml more colloid than the control group and the length of stay and complications were both reduced. What is different however is the monitoring parameter used as the targeted endpoint. Correspondence jonathan.rjt.wilson@york.nhs.uk Department of Anaesthesia York .