Von der Goal-Directed Therapy zum personalisierten hämodynamischen Monitoring

Abstract: The article describes the transition from traditional goal-directed therapy (GDT) to personalized hemodynamic management in the perioperative setting. The primary objective of hemodynamic optimization is to ensure adequate tissue oxygenation, determined by arterial oxygen content and cardiac output. The latter is mainly influenced by preload, afterload, and myocardial contractility. Static preload parameters such as central venous pressure have limited predictive value for fluid responsiveness, whereas dynamic indices (SVV, PPV) may provide superior guidance under specific conditions.Large randomized trials (e.g., OPTIMISE, iPEGASUS) failed to demonstrate consistent outcome benefits of standardized algorithms targeting fixed hemodynamic thresholds. In contrast, personalized hemodynamic management aims to define individual target values-such as mean arterial pressure or cardiac index-based on patient-specific risk factors and comorbidities. Some studies (e.g., INPRESS, TAPIR) suggest potential advantages of individualized strategies, whereas others (IMPROVE) did not confirm significant differences in major outcomes.Current guidelines recommend advanced hemodynamic monitoring in high-risk patients but do not define universal target values. A cardiac index-guided, individualized approach integrating clinical and metabolic indicators appears promising. However, rigid algorithm application and indiscriminate inotrope use should be avoided. Clinical judgment remains essential for delivering safe, patient-centered perioperative care.