Individualized goal directed perioperative care - The way to go!

Abstract

Treating critically ill and high-risk patients is one of the greatest challenges in medicine, and it is also a multidisciplinary task. Practice varies country by country resulting in a large scatter in outcome data, which makes the interpretation difficult. Regarding anesthesia and surgery, based on an international 7 day cohort, the EUSOS-study, conducted in 28 countries in Europe including 46,000 patients undergoing inpatient surgery, the overall mortality was 4%, which was higher than expected (1). What is even more surprising that 73% of the patients who died were never admitted to an intensive care unit (ICU). One of the leading reasons of an unfavorable outcome is inadequate perioperative hemodynamic management. Although this statement is widely accepted, yet fluids and catecholamines are commonly prescribed to subjective criteria (2). Several large prospective randomized trials have recently studied the effects of advanced hemodynamic monitoring based perioperative goal-directed therapy (3-7). There is also gathering evidence in other fields of perioperative care that patients should be treated according to individualized, physiology based values rather than guidelines or treatment bundles determined values (8). These results may lead to a paradigm shift in critical care medicine and change our practice from a protocolized "figure based" management to treating patients according to their individual and actual needs.