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A resuscitation strategy devised for patients with hypotension from septic shock that is based upon achieving specific physiologic end-points within 6 hours of hospital admission has been termed Early Goal-Directed Therapy (EGDT). This approach has been endorsed by the ‘‘Surviving Sepsis Campaign’’113 and has gained considerable acceptance despite only one, single-center, RCT evaluating its effectiveness. This protocolized strategy, consisting of fluids, vasoactive medication, and blood transfusions targeting physiological parameters, is recommended by many experts for the prevention of organ injury in septic-shock patients.
Similarly, protocolized care strategies in surgical patients at high risk for postoperative AKI have been extensively studied in an effort to provide optimal oxygen delivery to tissues in the perioperative period. In these patients, goaldirected therapy is defined as hemodynamic monitoring with defined target values and with a time limit to reach these stated goals. Together these protocols with bundled, hemodynamic, and tissue-support measures have the potential to reduce the risk of AKI following major surgical procedures in high-risk patients (e.g., age >60 years, emergent surgery, elevated American Society of Anesthesiologists score, preoperative comorbid illnesses).
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