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<p>Recent attention has focused on intraoperative hypotension (IOH) and hemodynamic instability. This enhanced awareness to limit IOH, combined with fluid restriction and increased vasopressor use, has been associated with an increase in postoperative acute kidney injury. Recent literature supports improved intraoperative monitoring of mean arterial pressure (MAP), fluid management, and appropriate use of vasopressors and inotropic support for hemodynamic management. Implementing an algorithm to manage the causes of IOH minimizes iatrogenic harm by guiding anesthesia clinicians to select the appropriate interventions at the optimal time. This ensures a comprehensive evaluation of contributing factors such as fluid deficits, myocardial depression, and vasodilation. Shifting attention from the MAP displayed on the physiologic monitor to more individualized care with a goal-directed therapy approach may improve patient outcomes.</p>

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Goal-directed therapy: what is the goal again?

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年5月16日

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  • Amy Yerdon,
  • Ken Taylor,
  • Katie Woodfin,
  • Ryan Richey,
  • Susan McMullan,
  • Desirée Chappell

摘要

Recent attention has focused on intraoperative hypotension (IOH) and hemodynamic instability. This enhanced awareness to limit IOH, combined with fluid restriction and increased vasopressor use, has been associated with an increase in postoperative acute kidney injury. Recent literature supports improved intraoperative monitoring of mean arterial pressure (MAP), fluid management, and appropriate use of vasopressors and inotropic support for hemodynamic management. Implementing an algorithm to manage the causes of IOH minimizes iatrogenic harm by guiding anesthesia clinicians to select the appropriate interventions at the optimal time. This ensures a comprehensive evaluation of contributing factors such as fluid deficits, myocardial depression, and vasodilation. Shifting attention from the MAP displayed on the physiologic monitor to more individualized care with a goal-directed therapy approach may improve patient outcomes.