KDIGO Clinical Practice Guideline for Acute Kidney Injury
Goal-directed therapy for hemodynamic support during the perioperative period in high-risk surgical patients

Goal-directed therapy for hemodynamic support during the perioperative period in high-risk surgical patients

Efforts to improve tissue oxygen delivery by optimizing hemodynamic support in high-risk surgical patients to prevent AKI and other adverse patient outcomes have been investigated for many years.^124-126 A recent meta-analysis of these studies by Brienza et al.¹²⁷ concluded that protocolized therapies (regardless of the protocol) with specific physiological goals can significantly reduce postoperative AKI. A major problem in interpreting these studies is the lack of standardized hemodynamic and tissue oxygenation targets and management strategies used to verify the efficacy of these measures over standard perioperative care. A heterogeneous collection of study populations, types of surgical procedures, monitoring methods, and treatment strategies comprise this recent meta-analysis.¹²⁷ The basic strategy of goal-directed therapy to prevent AKI in the perioperative period is based on protocols that avoid hypotension, optimize oxygen delivery, and include careful fluid management, vasopressors when indicated, and inotropic agents and blood products if needed.¹²⁷

The relative merits and risk:benefit ratio of each discrete element of EGDT in the successful resuscitation of patients with septic shock requires further study. Given the limitations of the current studies and lack of comparative effectiveness studies comparing individual protocols, we can only conclude that protocols for resuscitation in the setting of septic shock and high-risk surgery appear to be superior to no protocol.