Goal directed perfusión: Sistematic review.

Abstract

The concept of goal-directed perfusion consists of the use of variables derived from oxygen and carbon dioxide to optimize extracorporeal circulation, avoiding anaerobic metabolism and consequently the aggression to target organs. The objective of the present work is to evaluate the impacts of the use of goal-directed perfusion in the management of perfusion and in the postoperative period. For this, a systematic review of studies published in the last 10 years in the PubMed/MEDLINE database was performed using the descriptor “goal-directed perfusion”. After the successive stages of analysis, 15 articles fit the objective of this study. Two of the articles included are randomized studies, the others correspond to observational studies, being 10 retrospective and 3 prospective. In total, the studies evaluated 40,904 patients. Of the included articles, 11 had as main objective to evaluate the relationship between goal-directed perfusion strategies and the incidence of acute kidney injury, 3 evaluated the relationship of goal-directed perfusion with some predictive marker of neurological injury and 1 only evaluated the association of goal-directed perfusion with increased serum lactate. The qualitative analysis of the articles included in this review showed that the goal-directed perfusion technique can be considered a promising strategy to minimize organ dysfunction, especially acute kidney injury. However, it is important that the technique be better standardized, allowing greater reproducibility of such results in future studies.

Keywords or descriptors: goal-directed perfusion, cardiopulmonary bypass, oxygen delivery.