{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:37:18Z","timestamp":1787071038299,"version":"build-2736575974"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2016,10]]},"abstract":"<jats:p>\n                    Goal-directed therapy (GDT) encompasses guidance of intravenous (IV) fluid and vasopressor\/inotropic therapy by cardiac output or similar parameters to help in early recognition and management of high-risk cardiac surgical patients. With the aim of establishing the utility of perioperative GDT using robust clinical and biochemical outcomes, we conducted the present study. This multicenter randomized controlled study included 130 patients of either sex, with European system for cardiac operative risk evaluation \u22653 undergoing coronary artery bypass grafting on cardiopulmonary bypass. The patients were randomly divided into the control and GDT group. All the participants received standardized care; arterial pressure monitored through radial artery, central venous pressure (CVP) through a triple lumen in the right internal jugular vein, electrocardiogram, oxygen saturation, temperature, urine output per hour, and frequent arterial blood gas (ABG) analysis. In addition, cardiac index (CI) monitoring using FloTrac\u2122 and continuous central venous oxygen saturation (ScVO\n                    <jats:sub>2<\/jats:sub>\n                    ) using PreSep\u2122 were used in patients in the GDT group. Our aim was to maintain the CI at 2.5\u20134.2 L\/min\/m\n                    <jats:sup>2<\/jats:sup>\n                    , stroke volume index 30\u201365 ml\/beat\/m\n                    <jats:sup>2<\/jats:sup>\n                    , systemic vascular resistance index 1500\u20132500 dynes\/s\/cm\n                    <jats:sup>5<\/jats:sup>\n                    \/m\n                    <jats:sup>2<\/jats:sup>\n                    , oxygen delivery index 450\u2013600 ml\/min\/m\n                    <jats:sup>2<\/jats:sup>\n                    , continuous ScVO\n                    <jats:sub>2<\/jats:sub>\n                    &gt;70%, and stroke volume variation &lt;10%; in addition to the control group parameters such as CVP 6\u20138 mmHg, mean arterial pressure 90\u2013105 mmHg, normal ABG values, oxygen saturation, hematocrit value &gt;30%, and urine output &gt;1 ml\/kg\/h. The aims were achieved by altering the administration of IV fluids and doses of inotropes or vasodilators. The data of sixty patients in each group were analyzed in view of ten exclusions. The average duration of ventilation (19.89 \u00b1 3.96 vs. 18.05 \u00b1 4.53 h,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    = 0.025), hospital stay (7.94 \u00b1 1.64 vs. 7.17 \u00b1 1.93 days,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    = 0.025), and Intensive Care Unit (ICU) stay (3.74 \u00b1 0.59 vs. 3.41 \u00b1 0.75 days,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    = 0.012) was significantly less in the GDT group, compared to the control group. The extra volume added and the number of inotropic dose adjustments were significantly more in the GDT group. The two groups did not differ in duration of inotropic use, mortality, and other complications. The perioperative continuation of GDT affected the early decline in the lactate levels after 6 h in ICU, whereas the control group demonstrated a settling lactate only after 12 h. Similarly, the GDT group had significantly lower levels of brain natriuretic peptide, neutrophil gelatinase-associated lipocalin levels as compared to the control. The study clearly depicts the advantage of GDT for a favorable postoperative outcome in high-risk cardiac surgical patients.\n                  <\/jats:p>","DOI":"10.4103\/0971-9784.191552","type":"journal-article","created":{"date-parts":[[2016,10,7]],"date-time":"2016-10-07T02:21:40Z","timestamp":1475806900000},"page":"638-645","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":36,"title":["Perioperative utility of goal-directed therapy in high-risk cardiac patients undergoing coronary artery bypass grafting: \u201cA clinical outcome and biomarker-based study\u201d"],"prefix":"10.4103","volume":"19","author":[{"given":"Poonam Malhotra","family":"Kapoor","sequence":"first","affiliation":[{"name":"Department of Cardiac Anaesthesia, CTC, AIIMS, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohan","family":"Magoon","sequence":"additional","affiliation":[{"name":"Department of Cardiac Anaesthesia, CTC, AIIMS, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajinder","family":"Rawat","sequence":"additional","affiliation":[{"name":"Department of Cardiac Anaesthesiology, Salalah Heart Center, Salalah, Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yatin","family":"Mehta","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Critical Care, Medanta \u2013 The Medicity, Gurgaon, Haryana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20250921","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1016\/S1053-0770(96)80145-5","article-title":"Immediate postoperative care of cardiac surgical patients","volume":"10","author":"Higgins","year":"1996","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"R2-20250921","doi-asserted-by":"crossref","first-page":"1035","DOI":"10.1378\/chest.112.4.1035","article-title":"Predictors of outcome in cardiac surgical patients with prolonged intensive care stay","volume":"112","author":"Ryan","year":"1997","journal-title":"Chest"},{"key":"R3-20250921","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.1213\/00000539-199312000-00004","article-title":"Relation between oxygen consumption and oxygen delivery in patients after cardiac surgery","volume":"77","author":"Routsi","year":"1993","journal-title":"Anesth Analg"},{"key":"R4-20250921","doi-asserted-by":"crossref","first-page":"1575","DOI":"10.1161\/01.CIR.96.5.1575","article-title":"Effect of cardiac surgery patient characteristics on patient outcomes from 1981 through 1995","volume":"96","author":"Warner","year":"1997","journal-title":"Circulation"},{"key":"R5-20250921","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1097\/00003246-198206000-00015","article-title":"Clinical trial of survivors\u2019 cardiorespiratory patterns as therapeutic goals in critically ill postoperative patients","volume":"10","author":"Shoemaker","year":"1982","journal-title":"Crit Care Med"},{"key":"R6-20250921","first-page":"833","article-title":"Physiologic monitoring goals for the critically ill patient","volume":"147","author":"Bland","year":"1978","journal-title":"Surg Gynecol Obstet"},{"key":"R7-20250921","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1001\/jama.1994.03510270072043","article-title":"Multiple organ failure syndrome in the 1990s. 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