Anthony Holley, BSc, MBBCh (Wits), Dip Paeds, Dip DHM, FACEM, FCICM, Senior Staff Specialist Intensive Care; William Lukin, MBBS, FACEM, Senior Staff Specialist Emergency Medicine; Jennifer Paratz, PhD, FACP, MPhty, Chair and Research Fellow; Tracey Hawkins, RN, Clinical Nurse Consultant; Robert Boots, MBBS, PhD, MMedSci, MHAIT, FRACP, FCICM, Deputy Director, Senior Staff Specialist; Jeffrey Lipman, MBBCh (Wits), DA(SA), FFA(SA), FFA(Crit Care)(SA), FCICM, MD, Director.
Review article: Part two: Goal-directed resuscitation – Which goals? Perfusion targets
Article first published online: 17 JAN 2012
© 2012 The Authors. EMA © 2012 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine
Emergency Medicine Australasia
Volume 24, Issue 2, pages 127–135, April 2012
How to Cite
Holley, A., Lukin, W., Paratz, J., Hawkins, T., Boots, R. and Lipman, J. (2012), Review article: Part two: Goal-directed resuscitation – Which goals? Perfusion targets. Emergency Medicine Australasia, 24: 127–135. doi: 10.1111/j.1742-6723.2011.01515.x
- Issue published online: 4 APR 2012
- Article first published online: 17 JAN 2012
- Accepted 30 October 2011
- goal directed;
Haemodynamic targets, such as cardiac output, mean arterial blood pressure and central venous oxygen saturations, remain crude predictors of tissue perfusion and oxygen supply at a cellular level. Shocked patients may appear adequately resuscitated based on normalization of global vital signs, yet they are still experiencing occult hypoperfusion. If targeted resuscitation is employed, appropriate use of end-points is critical. In this review, we consider the value of directing resuscitation at the microcirculation or cellular level. Current technologies available include sublingual capnometry, video microscopy of the microcirculation and near-infrared spectroscopy providing a measure of tissue oxygenation, whereas base deficit and lactate potentially provide a surrogate measure of the adequacy of global perfusion. The methodology and evidence for these technologies guiding resuscitation are considered in this narrative review.