Goal-directed therapy

Jump to: navigation, search

WikiDoc Resources for Goal-directed therapy

Articles

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

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

Cochrane Collaboration on Goal-directed therapy

Bandolier on Goal-directed therapy

TRIP on Goal-directed therapy

Clinical Trials

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 / Govt

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

Books

Books on Goal-directed therapy

News

Goal-directed therapy in the news

Be alerted to news on Goal-directed therapy

News trends on Goal-directed therapy

Commentary

Blogs on Goal-directed therapy

Definitions

Definitions of Goal-directed therapy

Patient Resources / Community

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

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)

CME Programs on Goal-directed therapy

International

Goal-directed therapy en Espanol

Goal-directed therapy en Francais

Business

Goal-directed therapy in the Marketplace

Patents on Goal-directed therapy

Experimental / Informatics

List of terms related to Goal-directed therapy


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]

Early Goal-Directed Therapy is most likely to benefit patients in institutions where the mortality rate for septic shock is high.[5]

Shown below is a the Forest plot depicting the different trials that evaluated Goal-Directed Therapy for septic shock. Early goal-directed therapy for reducing mortality from severe sepsis and septic shock.png

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

  1. Gordon A, Russell J, Crit Care. 2005; 9(6): 647–648. Published online 2005 November 23. doi: 10.1186/cc3951.
  2. 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
  3. Rossi AF, Khan D, Clin Biochem. 2004 Jun;37(6):456-61.
  4. Rivers, 2001 http://scalpel.stanford.edu/articles/Goal%20directed%20therapy.pdf
  5. openMetaAnalysis Contributors. Early goal directed therapy for septic shock: a living systematic review. GitHub. Available at http://openmetaanalysis.github.io/Early-goal-directed-therapy-for-septic-shock/. Accessed February 24, 2014.