Goal-directed haemodynamic therapy in cardiac surgery

Abstract

The concept of goal-directed haemodynamic optimisation was developed in the late 70s and early 80s of the last century by the surgeon W C Shoemaker.¹ Observational studies showed that high-risk surgical patients that did not survive after major non-cardiac surgery were characterised by the inability to adapt oxygen delivery to the perioperatively increased oxygen demand.^2,3 He suggested improving patients’ outcomes by optimising the cardiac index and oxygen delivery to the haemodynamic levels observed in survivors. Stimulated by Shoemaker’s ideas, he and various other researchers performed prospective studies that clearly supported this concept.^4,5,6,7