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Using oxygen delivery targets to optimize resuscitation in critically ill patients

Rampal, Tarannum; Jhanji, Shaman; Pearse, Rupert M

Current Opinion in Critical Care: June 2010 - Volume 16 - Issue 3 - p 244–249
doi: 10.1097/MCC.0b013e328338a929
Cardiopulmonary monitoring: Edited by Michael R. Pinsky

Purpose of review The use of fluid and inotropic therapies to optimize global haemodynamic variables, in particular oxygen delivery, in critically ill patients has been a controversial area of research for more than 25 years. The aim of this review is to describe the current evidence base for this treatment and how concepts of haemodynamic optimization have evolved in recent years.

Recent findings The inconsistent findings of a large number of small phase II trials continue to stimulate the debate about the value of this treatment approach. However, important recent developments include the use of optimization only during periods of resuscitation, more cautious doses of fluid and/or inotropic therapy, confirmation that pulmonary artery catheter use does not result in excess mortality and an improved understanding of the mechanistic effects of haemodynamic optimization.

Summary These advances in our understanding have now informed the design of large randomized trials in various patient groups. The true value of haemodynamic optimization is likely to be confirmed or refuted within the next 5 years.

Queen Mary's University of London, Barts and The London School of Medicine and Dentistry, London, UK

Correspondence to Rupert Pearse, Intensive Care Unit, Royal London Hospital, London E1 1BB, UK Tel/fax: +44 207 377 7299; e-mail: rupert.pearse@bartsandthelondon.nhs.uk

© 2010 Lippincott Williams & Wilkins, Inc.