Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Optimal management of the high risk surgical patient: beta stimulation or beta blockade? | Available online http content 9 6 645 Commentary Optimal management of the high risk surgical patient beta stimulation or beta blockade Daniel De Backer Assistant Professor Department of Intensive Care Erasme University Hospital Free University of Brussels Belgium Corresponding author Daniel De Backer ddebacke@ Published online 22 November 2005 This article is online at http content 9 6 645 2005 BioMed Central Ltd Critical Care 2005 9 645-646 DOI cc3930 See related research by Pearse et al. in this issue http content 9 6 R687 and http content 9 6 R694 Abstract Several groups of investigators have shown that peri-operative goal directed therapy GDT may reduce mortality in high-risk surgical patients. GDT usually requires the use of beta-adrenergic agents however and these may also carry the risk of cardiac ischemia especially in patients with ischemic diseases. In this commentary we will discuss the apparent contradiction between studies showing beneficial effects of GDT in high-risk surgical patients and studies showing the benefit of beta-blockade in high-risk surgery. One of the key differences between both types of studies is that GDT is applied in patients with high risk of postoperative death excluding patients with cardiac ischemic disease while studies reporting beneficial effects of beta-blockade have investigated patients with high risk of cardiac ischemia but moderate risk of death related to the surgical procedure itself. It is likely that beta-blockade should be proposed in patients with moderate risk of death whereas GDT using fluids and inotropic agents should be applied in patients with high risk of peri-operative death. Monitoring central venous oxygen saturation may be useful to individualize therapy but further studies are required to validate this option. The peri-operative care of high-risk surgical patients remains a challenge. Despite improvement in surgical and .
