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: Goal-directed or goal-misdirected – how should we interpret the literature? | Roche and Miller Critical Care 2010 14 129 http content 14 2 129 CRITICAL CARE COMMENTARY L__ Goal-directed or goal-misdirected - how should we interpret the literature Anthony M Roche and Timothy E Miller See related review by Lees etal. http content 13 5 231 Abstract Goal-directed therapy GDT can be a vague term meaning different things to different people and depending on the clinical environment sometimes even different things to the same person. It can refer to perioperative fluid management clinicians driving oxygen delivery to supramaximal values early treatment of sepsis in the emergency department and even to restriction of perioperative crystalloids with the goal of maintaining preadmission body weight. Understandably strong opinions about GDT vary some clinicians consider it essential for perioperative care others completely ineffective in critically ill patients. This commentary aims to further position the excellent review by Lees and colleagues in the context of the critical care and perioperative setting. Given the confusion and strong opinions surrounding goal-directed therapy GDT Lees and colleagues 1 have done a commendable job of clearly defining GDT and how it pertains to each clinical setting as well as separately examining the individual bodies of relevant literature. The authors separate the physiologic and pathophysiologic discussion of both the perioperative and septic patient populations thus contextualizing different approaches to both volume and hemodynamic GDT. Despite the encouraging body of literature in the early days of oxygen-targeted approaches to early GDT oxygen delivery DO2 of greater than 600 mL min per m 2 2-4 more recent studies have not confirmed these results 5 6 . Much speculation and controversy surrounds this technique where it appears that no benefit if not worse outcomes are being observed in patients with established Correspondence Department of Anesthesiology DUMC
