Goal-directed therapy: hit early and personalize!

Excerpt

The serial or continuous assessment of hemodynamic variables—called hemodynamic monitoring—allows the evaluation of changes in cardiovascular dynamics and is recommended in patients at risk of hemodynamic instability in perioperative and intensive care medicine [1‐3]. Aiming to achieve specific target values of hemodynamic variables is referred to as “goal-directed therapy” (GDT). Whether performing GDT enables patient outcome to be improved is a matter of ongoing scientific evaluation and debate. Therefore, Cronhjort and colleagues should be commended for having performed a systematic review and meta-analysis on the impact of protocolized GDT on mortality in adult critically ill patients [4]. The authors analyzed 13 randomized, clinical, open-label trials including patients treated in the intensive care unit (ICU), emergency department, or “corresponding level of care”, only 6 of which were high quality trials with low risk of bias [4]. To be eligible for inclusion in their meta-analysis, studies needed to define its control group as standard of care (including measurement of central venous pressure) without any structured hemodynamic intervention [4]. The authors revealed no clinically relevant or statistically significant reduction in all-cause mortality with GDT [4]. …