Goal-directed therapy
You don't need to be Editor-In-Chief to add or edit content to WikiDoc. You can begin to add to or edit text on this WikiDoc page by clicking on the edit button at the top of this page. Next enter or edit the information that you would like to appear here. Once you are done editing, scroll down and click the Save page button at the bottom of the page.
Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [1] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.
Overview
Goal-Directed Therapy is a technique used in critical care medicine involving intensive monitoring and aggressive management of perioperative hemodynamics in patients with a high risk of morbidy and mortality.[1] In cardiac surgery, GDT has proved effective when commenced after surgery. The combination of goal-directed therapy and Point-of-Care Testing has demonstrated a marked decrease in mortality for patients undergoing congenital heart surgery.[2] Further more, a reduction in morbidity and mortality has been associated with GDT techniques when used in conjunction with an electronic medical record.[3]
Early Goal-Directed Therapy is a more specific form of therapy used for the treatment of severe sepsis and septic shock. This approach involves adjustments of cardiac preload, afterload, and contractility to balance oxygen delivery with an increased oxygen demand before surgery.[4]
Elements
In the event of hypotension and/or lactate > 4 mmol/L, then deliver an initial minimum of 20 ml/kg of crystalloid (or colloid equivalent).
Apply vasopressors for hypotension not responding to initial fluid resuscitation to maintain mean arterial pressure (MAP) > 65 mm Hg.
In the event of persistent hypotension despite fluid resuscitation (septic shock) and/or lactate > 4 mmol/L (36 mg/dl):
- Achieve central venous pressure (CVP) of > 8 mm Hg
- Achieve central venous oxygen saturation (ScvO2) of > 70%
References
- ↑ Gordon A, Russell J, Crit Care. 2005; 9(6): 647–648. Published online 2005 November 23. doi: 10.1186/cc3951.
- ↑ Rossi AF, Khan DM, Hannan R, Boliver J, Zaidenweber M, Burke R, Intensive Care Med. 2005 Jan;31(1):98-104. Epub 2004 Dec 1
- ↑ Rossi AF, Khan D, Clin Biochem. 2004 Jun;37(6):456-61.
- ↑ Rivers, 2001 http://scalpel.stanford.edu/articles/Goal%20directed%20therapy.pdf
WikiDoc Research Resources for Goal-directed therapy | |
|---|---|
| Articles on Goal-directed therapy | Most recent articles on Goal-directed therapy • Most cited articles on Goal-directed therapy • Review articles on Goal-directed therapy • Articles on Goal-directed therapy in N Eng J Med, Lancet, BMJ |
| Media (Slides, Video, Images, MP3) on Goal-directed therapy | Powerpoint slides on Goal-directed therapy • Images of Goal-directed therapy • Photos of Goal-directed therapy • Podcasts & MP3s on Goal-directed therapy • Videos on Goal-directed therapy |
| Evidence Based Medicine Regarding Goal-directed therapy | Cochrane Collaboration on Goal-directed therapy • Bandolier on Goal-directed therapy • TRIP on Goal-directed therapy |
| Cost Effectiveness of Goal-directed therapy | Cost Effectiveness of Goal-directed therapy |
| Clinical Trials Involving Goal-directed therapy | Ongoing Trials on Goal-directed therapy at Clinical Trials.gov • Trial results on Goal-directed therapy • Clinical Trials on Goal-directed therapy at Google |
| Guidelines / Policies / Government Resources (FDA/CDC) Regarding Goal-directed therapy | US National Guidelines Clearinghouse on Goal-directed therapy • NICE Guidance on Goal-directed therapy • NHS PRODIGY Guidance • FDA on Goal-directed therapy • CDC on Goal-directed therapy |
| Textbook Information on Goal-directed therapy | Books and Textbook Information on Goal-directed therapy |
| Pharmacology Resources on Goal-directed therapy | Dosing of Goal-directed therapy • Drug interactions with Goal-directed therapy • Side effects of Goal-directed therapy • Allergic reactions to Goal-directed therapy • Overdose information on Goal-directed therapy • Carcinogenicity information on Goal-directed therapy • Goal-directed therapy in pregnancy • Pharmacokinetics of Goal-directed therapy • |
| Genetics, Pharmacogenomics, and Proteinomics of Goal-directed therapy | Genetics of Goal-directed therapy • Pharmacogenomics of Goal-directed therapy • Proteomics of Goal-directed therapy |
| Newstories on Goal-directed therapy | Goal-directed therapy in the news • Be alerted to news on Goal-directed therapy • News trends on Goal-directed therapy |
| Commentary on Goal-directed therapy | Blogs on Goal-directed therapy |
| Patient Resources on Goal-directed therapy | Patient resources on Goal-directed therapy • Discussion groups on Goal-directed therapy • Patient Handouts on Goal-directed therapy • Directions to Hospitals Treating Goal-directed therapy • Risk calculators and risk factors for Goal-directed therapy |
| Healthcare Provider Resources on Goal-directed therapy | Symptoms of Goal-directed therapy • Causes & Risk Factors for Goal-directed therapy • Diagnostic studies for Goal-directed therapy • Treatment of Goal-directed therapy |
| Continuing Medical Education (CME) Programs on Goal-directed therapy | CME Programs on Goal-directed therapy |
| International Resources on Goal-directed therapy | Goal-directed therapy en Espanol • Goal-directed therapy en Francais |
| Business Resources on Goal-directed therapy | Goal-directed therapy in the Marketplace • Patents on Goal-directed therapy |
| Informatics Resources on Goal-directed therapy | List of terms related to Goal-directed therapy |
| ||||
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
