ABSTRACT
Goal-directed therapy is a patient care strategy that has been implemented to improve patient outcomes. The strategy includes aggressive patient management and monitoring during a period of critical care. Goal-directed therapy has been adapted to perfusion and has been designated goal-directed perfusion (GDP). Since this is a new concept in perfusion, the purpose of this study is to review goal-directed therapy research in other areas of critical care management and compare that process to improving patient outcomes following cardiopulmonary bypass. Various areas of goaldirected therapy literature were reviewed, including fluid administration, neurologic injury, tissue perfusion, oxygenation, and inflammatory response. Data from these studies was compiled to document improvements in patient outcomes. Goal-directed therapy has been demonstrated to improve patient outcomes when performed within the optimal time frame resulting in decreased complications, reduction in hospital stay, and a decrease in morbidity. Based on the successes in other critical care areas, GDP during cardiopulmonary bypass would be expected to improve outcomes following cardiac surgery.
Subject(s)
Cardiopulmonary Bypass/history , Delivery of Health Care/history , Myocardial Reperfusion/history , Cardiopulmonary Bypass/methods , Delivery of Health Care/methods , History, 20th Century , History, 21st Century , Humans , Myocardial Reperfusion/methods , Treatment OutcomeSubject(s)
Myocardial Infarction/therapy , Myocardial Reperfusion/methods , Combined Modality Therapy , Fibrinolytic Agents/history , Fibrinolytic Agents/therapeutic use , History, 20th Century , History, 21st Century , Humans , Myocardial Infarction/history , Myocardial Reperfusion/history , Percutaneous Coronary Intervention/history , Percutaneous Coronary Intervention/methodsSubject(s)
Myocardial Infarction/history , Myocardial Reperfusion/history , Animals , Catheter Ablation/history , Coronary Artery Bypass/history , Europe , Germany , History, 20th Century , History, 21st Century , Humans , Intra-Aortic Balloon Pumping/history , Myocardial Infarction/therapy , Myocardial Reperfusion/methods , United StatesSubject(s)
Cardiology/history , Myocardial Ischemia/therapy , Cardiology/economics , Germany , History, 20th Century , History, 21st Century , Humans , Myocardial Ischemia/history , Myocardial Reperfusion/history , Myocardial Reperfusion/methods , Societies, Medical/economics , Societies, Medical/historyABSTRACT
A reperfusão coronária promoveu marcante transformação no tratamento dos pacientes com infarto do miocárdio, beneficiando grande número de enfermos no último quarto do século passado. O método mais adequado deve promover a lise do trombo coronário oclusivo e reduzir simultaneamente, a estenose coronária subjacente, que, associadas, constituem o binômio patogênico para o estabelecimento do infarto agudo do miocárdio. A primeira série de 12 pacientes consecutivos submetidos à angioplastia transluminal coronária na vigência de infarto agudo do miocárdio, sem o uso prévio de fibrinolíticos, foi relatada em 1983. A patir de 1993, foram realizados estudos randomizados, comparando os dois métodos de reperfusão coronária, farmacológico e mecânico...
Subject(s)
Angioplasty, Balloon , Coronary Stenosis , Myocardial Infarction/therapy , Myocardial Reperfusion/history , StentsABSTRACT
Com o uso cada vez mais frequente de técnicas de reperfusão miocárdica (trombose, angioplastia e cirurgia) maior interesse tem sido despertado por medidas que possam otimizar os resultados destes procedimentos. Uma dessas medidas é a prevenção do fenômeno conhecido como "injúria de reperfusão miocárdica". Este fenômeno, outrora de importância e até mesmo de existência discutível, é hoje estudado em todos os grandes centros de pesquisa do mundo levando a um rápido acúmulo de conhecimentos. Embora muitas dúvidas permaneçam, trata-se, sem dúvida, de um assunto importante, empolgante e promissor.
