Arterial pressure variation and goal-directed fluid therapy.

摘要

FLUID MANAGEMENT AND OPTIMIZATION are daily problems in anesthesiology and in the critical care setting. Hemodynamic management is related to the optimization of oxygen delivery to the tissues and has been shown to be able to improve postoperative outcome and to decrease the cost of surgery.Schematically, in the operating room, the anesthesiologist and his/her patients have to deal with 2 distinct risks: hypovolemia on one side and hypervolemia on the other side. Both risks potentially can lead to a decrease in oxygen delivery to the tissues and to an increase in postoperative morbidity (Fig 1). However, despite evidence showing that organ perfusion requires 2 physiologic objectives, adequate perfusion pressure in order to force blood into the capillaries of all organs and adequate cardiac output to deliver oxygen and substrates and to remove carbon dioxide and other metabolic products, and despite data showing the impact of cardiac output optimization on postoperative outcome, cardiac output monitoring rarely is used in the daily anesthesiology practice; clinicians still rely on clinical judgment, blood loss estimates, and the vague concept of third-space losses.