Prospective Trial of Supranormal Values of Survivors as Therapeutic Goals in High-Risk Surgical Patients: Discussion

In: Surgical Patients

16 Mar 2015

The cardiac output, Do2 and Vo2 values were higher in the protocol patients than in the control patients, while the other monitored variables were not appreciably different, indicating that there was reasonable compliance with the protocol. The higher Cl and Do2 values are consistent with the concept that this pattern represents compensatory increases in circulatory function needed to meet the increased metabolic requirements reflected by Vo2. The present study suggests that this augmented circulatory response represents appropriate goals of therapy for the critically ill noncardiac surgical patient. However, the protocol, defined by median values of survivors may be overly aggressive for elderly patients with limited capacity for physiologic compensation and it may be unattainable or ineffective for overwhelming lethal disease.

The results of series 2 indicate no significant difference in outcome between high-risk surgical patients managed perioperatively with PA catheters and those managed with CVP catheters, unless the PA catheter data are used to augment rather than simply normalize circulatory parameters. Institution of PA catheter monitoring selectively after complications or physiologic decompensations occur did not significantly affect group outcome. In contrast, cardiorespiratory data obtained beginning with the preoperative and intraoperative period may provide crucial early warning of potential circulatory decompensation for high-risk patients. Clearly, the risk-benefit of PA catheters used to augment physiologic compensations is favorable as the PA catheter complications were relatively few and transient. natural breast enhancement pill
The PA catheters are most often placed for the management of patients who have compromised cardiovascular function. The population studied in this report is different in that the primary indication for invasive monitoring was high-risk surgery rather than a primary cardiovascular disease. Our data indicate that in these circumstances, the accepted normal hemodynamic standards are applied too broadly. Normalization of hemodynamic values appropriate for the cardiac patient may be inappropriate for the general surgical patient in the perioperative period.

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