Perfusión dirigida por objetivos: práctica actual en técnicas de circulación extracorpórea

Abstract

Extracorporeal circulation (ECC) is an essential component of cardiac surgery since it allows life support to be maintained during the induced cardiac arrest necessary to perform cardiosurgical interventions. However, CPB presents adverse effects at a local and systemic level because its components produce alterations at the macro- and microcirculation levels, potentially leading to hypoperfusion. The goal-directed perfusion (GDP) technique seeks to personalize hemodynamic management according to predefined goals, thereby optimizing tissue oxygenation and perfusion during CPB. This implies constant monitoring of key parameters, to make real-time changes to perfusion strategies. Over the past 10 years, the benefits of using GDP have been explored and its superiority over the traditional approach visualized. The objective of this article is to describe GDP practice in monitoring during CPB. We will focus on the existing variables monitored under the GDP concept, applying and manipulating them to optimize tissue perfusion in real-time.