Optimal management of the high risk surgical patient: beta stimulation or beta blockade?

Abstract Several groups of investigators have shown that peri-operative goal directed therapy (GDT) may reduce mortality in high-risk surgical patients. GDT usually requires the use of beta-adrenergic agents, however, and these may also carry the risk of cardiac ischemia, especially in patients with...
Ausführliche Beschreibung

Gespeichert in:

Autor*in:	De Backer, Daniel [verfasserIn]

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2005

Schlagwörter:	Goal Directed Therapy Dopexamine Central Venous Oxygen Saturation Revise Cardiac Risk Index Cardiac Risk Index

Anmerkung:	© BioMed Central Ltd 2005

Übergeordnetes Werk:	Enthalten in: Critical care - London : BioMed Central, 1997, 9(2005), 6 vom: 22. Nov.
Übergeordnetes Werk:	volume:9 ; year:2005 ; number:6 ; day:22 ; month:11

Links:	Volltext

DOI / URN:	10.1186/cc3930

Katalog-ID:	SPR029765838

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spelling	10.1186/cc3930 doi (DE-627)SPR029765838 (SPR)cc3930-e DE-627 ger DE-627 rakwb eng De Backer, Daniel verfasserin aut Optimal management of the high risk surgical patient: beta stimulation or beta blockade? 2005 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © BioMed Central Ltd 2005 Abstract Several groups of investigators have shown that peri-operative goal directed therapy (GDT) may reduce mortality in high-risk surgical patients. GDT usually requires the use of beta-adrenergic agents, however, and these may also carry the risk of cardiac ischemia, especially in patients with ischemic diseases. In this commentary, we will discuss the apparent contradiction between studies showing beneficial effects of GDT in high-risk surgical patients and studies showing the benefit of beta-blockade in high-risk surgery. One of the key differences between both types of studies is that GDT is applied in patients with high risk of postoperative death, excluding patients with cardiac ischemic disease, while studies reporting beneficial effects of beta-blockade have investigated patients with high risk of cardiac ischemia but moderate risk of death related to the surgical procedure itself. It is likely that beta-blockade should be proposed in patients with moderate risk of death, whereas GDT using fluids and inotropic agents should be applied in patients with high risk of peri-operative death. Monitoring central venous oxygen saturation may be useful to individualize therapy, but further studies are required to validate this option. Goal Directed Therapy (dpeaa)DE-He213 Dopexamine (dpeaa)DE-He213 Central Venous Oxygen Saturation (dpeaa)DE-He213 Revise Cardiac Risk Index (dpeaa)DE-He213 Cardiac Risk Index (dpeaa)DE-He213 Enthalten in Critical care London : BioMed Central, 1997 9(2005), 6 vom: 22. Nov. (DE-627)331258269 (DE-600)2051256-9 1364-8535 nnns volume:9 year:2005 number:6 day:22 month:11 https://dx.doi.org/10.1186/cc3930 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 9 2005 6 22 11
allfields_unstemmed	10.1186/cc3930 doi (DE-627)SPR029765838 (SPR)cc3930-e DE-627 ger DE-627 rakwb eng De Backer, Daniel verfasserin aut Optimal management of the high risk surgical patient: beta stimulation or beta blockade? 2005 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © BioMed Central Ltd 2005 Abstract Several groups of investigators have shown that peri-operative goal directed therapy (GDT) may reduce mortality in high-risk surgical patients. GDT usually requires the use of beta-adrenergic agents, however, and these may also carry the risk of cardiac ischemia, especially in patients with ischemic diseases. In this commentary, we will discuss the apparent contradiction between studies showing beneficial effects of GDT in high-risk surgical patients and studies showing the benefit of beta-blockade in high-risk surgery. One of the key differences between both types of studies is that GDT is applied in patients with high risk of postoperative death, excluding patients with cardiac ischemic disease, while studies reporting beneficial effects of beta-blockade have investigated patients with high risk of cardiac ischemia but moderate risk of death related to the surgical procedure itself. It is likely that beta-blockade should be proposed in patients with moderate risk of death, whereas GDT using fluids and inotropic agents should be applied in patients with high risk of peri-operative death. Monitoring central venous oxygen saturation may be useful to individualize therapy, but further studies are required to validate this option. Goal Directed Therapy (dpeaa)DE-He213 Dopexamine (dpeaa)DE-He213 Central Venous Oxygen Saturation (dpeaa)DE-He213 Revise Cardiac Risk Index (dpeaa)DE-He213 Cardiac Risk Index (dpeaa)DE-He213 Enthalten in Critical care London : BioMed Central, 1997 9(2005), 6 vom: 22. Nov. (DE-627)331258269 (DE-600)2051256-9 1364-8535 nnns volume:9 year:2005 number:6 day:22 month:11 https://dx.doi.org/10.1186/cc3930 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 9 2005 6 22 11
allfieldsGer	10.1186/cc3930 doi (DE-627)SPR029765838 (SPR)cc3930-e DE-627 ger DE-627 rakwb eng De Backer, Daniel verfasserin aut Optimal management of the high risk surgical patient: beta stimulation or beta blockade? 2005 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © BioMed Central Ltd 2005 Abstract Several groups of investigators have shown that peri-operative goal directed therapy (GDT) may reduce mortality in high-risk surgical patients. GDT usually requires the use of beta-adrenergic agents, however, and these may also carry the risk of cardiac ischemia, especially in patients with ischemic diseases. In this commentary, we will discuss the apparent contradiction between studies showing beneficial effects of GDT in high-risk surgical patients and studies showing the benefit of beta-blockade in high-risk surgery. One of the key differences between both types of studies is that GDT is applied in patients with high risk of postoperative death, excluding patients with cardiac ischemic disease, while studies reporting beneficial effects of beta-blockade have investigated patients with high risk of cardiac ischemia but moderate risk of death related to the surgical procedure itself. It is likely that beta-blockade should be proposed in patients with moderate risk of death, whereas GDT using fluids and inotropic agents should be applied in patients with high risk of peri-operative death. Monitoring central venous oxygen saturation may be useful to individualize therapy, but further studies are required to validate this option. Goal Directed Therapy (dpeaa)DE-He213 Dopexamine (dpeaa)DE-He213 Central Venous Oxygen Saturation (dpeaa)DE-He213 Revise Cardiac Risk Index (dpeaa)DE-He213 Cardiac Risk Index (dpeaa)DE-He213 Enthalten in Critical care London : BioMed Central, 1997 9(2005), 6 vom: 22. Nov. (DE-627)331258269 (DE-600)2051256-9 1364-8535 nnns volume:9 year:2005 number:6 day:22 month:11 https://dx.doi.org/10.1186/cc3930 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 9 2005 6 22 11
allfieldsSound	10.1186/cc3930 doi (DE-627)SPR029765838 (SPR)cc3930-e DE-627 ger DE-627 rakwb eng De Backer, Daniel verfasserin aut Optimal management of the high risk surgical patient: beta stimulation or beta blockade? 2005 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © BioMed Central Ltd 2005 Abstract Several groups of investigators have shown that peri-operative goal directed therapy (GDT) may reduce mortality in high-risk surgical patients. GDT usually requires the use of beta-adrenergic agents, however, and these may also carry the risk of cardiac ischemia, especially in patients with ischemic diseases. In this commentary, we will discuss the apparent contradiction between studies showing beneficial effects of GDT in high-risk surgical patients and studies showing the benefit of beta-blockade in high-risk surgery. One of the key differences between both types of studies is that GDT is applied in patients with high risk of postoperative death, excluding patients with cardiac ischemic disease, while studies reporting beneficial effects of beta-blockade have investigated patients with high risk of cardiac ischemia but moderate risk of death related to the surgical procedure itself. It is likely that beta-blockade should be proposed in patients with moderate risk of death, whereas GDT using fluids and inotropic agents should be applied in patients with high risk of peri-operative death. Monitoring central venous oxygen saturation may be useful to individualize therapy, but further studies are required to validate this option. Goal Directed Therapy (dpeaa)DE-He213 Dopexamine (dpeaa)DE-He213 Central Venous Oxygen Saturation (dpeaa)DE-He213 Revise Cardiac Risk Index (dpeaa)DE-He213 Cardiac Risk Index (dpeaa)DE-He213 Enthalten in Critical care London : BioMed Central, 1997 9(2005), 6 vom: 22. Nov. (DE-627)331258269 (DE-600)2051256-9 1364-8535 nnns volume:9 year:2005 number:6 day:22 month:11 https://dx.doi.org/10.1186/cc3930 lizenzpflichtig Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2003 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 9 2005 6 22 11
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author	De Backer, Daniel
spellingShingle	De Backer, Daniel misc Goal Directed Therapy misc Dopexamine misc Central Venous Oxygen Saturation misc Revise Cardiac Risk Index misc Cardiac Risk Index Optimal management of the high risk surgical patient: beta stimulation or beta blockade?
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topic_title	Optimal management of the high risk surgical patient: beta stimulation or beta blockade? Goal Directed Therapy (dpeaa)DE-He213 Dopexamine (dpeaa)DE-He213 Central Venous Oxygen Saturation (dpeaa)DE-He213 Revise Cardiac Risk Index (dpeaa)DE-He213 Cardiac Risk Index (dpeaa)DE-He213
topic	misc Goal Directed Therapy misc Dopexamine misc Central Venous Oxygen Saturation misc Revise Cardiac Risk Index misc Cardiac Risk Index
topic_unstemmed	misc Goal Directed Therapy misc Dopexamine misc Central Venous Oxygen Saturation misc Revise Cardiac Risk Index misc Cardiac Risk Index
topic_browse	misc Goal Directed Therapy misc Dopexamine misc Central Venous Oxygen Saturation misc Revise Cardiac Risk Index misc Cardiac Risk Index
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title	Optimal management of the high risk surgical patient: beta stimulation or beta blockade?
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title_full	Optimal management of the high risk surgical patient: beta stimulation or beta blockade?
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title_sort	optimal management of the high risk surgical patient: beta stimulation or beta blockade?
title_auth	Optimal management of the high risk surgical patient: beta stimulation or beta blockade?
abstract	Abstract Several groups of investigators have shown that peri-operative goal directed therapy (GDT) may reduce mortality in high-risk surgical patients. GDT usually requires the use of beta-adrenergic agents, however, and these may also carry the risk of cardiac ischemia, especially in patients with ischemic diseases. In this commentary, we will discuss the apparent contradiction between studies showing beneficial effects of GDT in high-risk surgical patients and studies showing the benefit of beta-blockade in high-risk surgery. One of the key differences between both types of studies is that GDT is applied in patients with high risk of postoperative death, excluding patients with cardiac ischemic disease, while studies reporting beneficial effects of beta-blockade have investigated patients with high risk of cardiac ischemia but moderate risk of death related to the surgical procedure itself. It is likely that beta-blockade should be proposed in patients with moderate risk of death, whereas GDT using fluids and inotropic agents should be applied in patients with high risk of peri-operative death. Monitoring central venous oxygen saturation may be useful to individualize therapy, but further studies are required to validate this option. © BioMed Central Ltd 2005
abstractGer	Abstract Several groups of investigators have shown that peri-operative goal directed therapy (GDT) may reduce mortality in high-risk surgical patients. GDT usually requires the use of beta-adrenergic agents, however, and these may also carry the risk of cardiac ischemia, especially in patients with ischemic diseases. In this commentary, we will discuss the apparent contradiction between studies showing beneficial effects of GDT in high-risk surgical patients and studies showing the benefit of beta-blockade in high-risk surgery. One of the key differences between both types of studies is that GDT is applied in patients with high risk of postoperative death, excluding patients with cardiac ischemic disease, while studies reporting beneficial effects of beta-blockade have investigated patients with high risk of cardiac ischemia but moderate risk of death related to the surgical procedure itself. It is likely that beta-blockade should be proposed in patients with moderate risk of death, whereas GDT using fluids and inotropic agents should be applied in patients with high risk of peri-operative death. Monitoring central venous oxygen saturation may be useful to individualize therapy, but further studies are required to validate this option. © BioMed Central Ltd 2005
abstract_unstemmed	Abstract Several groups of investigators have shown that peri-operative goal directed therapy (GDT) may reduce mortality in high-risk surgical patients. GDT usually requires the use of beta-adrenergic agents, however, and these may also carry the risk of cardiac ischemia, especially in patients with ischemic diseases. In this commentary, we will discuss the apparent contradiction between studies showing beneficial effects of GDT in high-risk surgical patients and studies showing the benefit of beta-blockade in high-risk surgery. One of the key differences between both types of studies is that GDT is applied in patients with high risk of postoperative death, excluding patients with cardiac ischemic disease, while studies reporting beneficial effects of beta-blockade have investigated patients with high risk of cardiac ischemia but moderate risk of death related to the surgical procedure itself. It is likely that beta-blockade should be proposed in patients with moderate risk of death, whereas GDT using fluids and inotropic agents should be applied in patients with high risk of peri-operative death. Monitoring central venous oxygen saturation may be useful to individualize therapy, but further studies are required to validate this option. © BioMed Central Ltd 2005
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title_short	Optimal management of the high risk surgical patient: beta stimulation or beta blockade?
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