Goal-Directed Therapy in the Operating Room and in the Intensive Care Unit: Last Year in Review


Program Description / Statement of Need:

In this online CME self-learning program:

This presentation is from the second annual Goal Directed Therapy (GDT) Symposium organized by UC Irvine and UCLA. Faculty for this symposium are internationally recognized experts in the field and are from the US and from Europe. The symposium aims at promoting this concept that has been shown to improve patients' care and outcomes. The unique feature of this program is that it is constructed around a very practical program that intends to help attendees to apply GDT in their clinical practice. To achive this goal, the program will screen basic physiological concepts, and then show how to apply them in clinical priace, and will finally help participants to develop these specific programs within their institutions.. This program aims at promoting guidelines on hemodynamic optimization and fluid management, as well as promoting standards of care in the OR and ICU.




Studies highlighted:


  • Clinical review: update on hemodynamic monitoring – a consensus of 16
  • The U. K. National Health Service releases update and guidance on cardiac output monitoring in high-risk surgery
  • Managing perioperative risk in patients undergoing elective non-cardiac surgery
  • Randomized controlled trial of intraoperative goal-directed fluid therapy in aerobically fit and unfit patients having major colorectal surgery
  • Hospital stay and mortality are increased in patients having a “triple low” of low blood pressure, low bispectral index, and low minimum alveolar concentration of volatile anesthesia
  • Noninvasive continuous arterial blood pressure monitoring with Nexfin
  • Precision and accuracy of a new device (CNAP) for continuous non-invasive arterial pressure monitoring: assessment during general anaesthesia
  • Noninvasive continuous beat-to-beat radial artery pressure via TL-200 applanation tonometry
  • Prolonged central venous desaturation measured by continuous oximetry is associated with adverse outcomes in pediatric cardiac surgery


Target Audience:

This program has been designed for a multidisciplinary physician and nurse audience including: Emergency Medicine / ICU / Anesthesia / Peri-op / Intensivists / Trauma / Critical Care

Program Objectives:

By the end of the session the participant will be able to:

    • Describe how cardiac output can be monitored and optimized in high risk surgery patients in order to improve postoperative outcomes
    • Develop a Goal Directed Therapy program for patients undergoing high risk surgery in their institution
    • Apply guidelines for fluid management and hemodynamic optimization in their daily clinical practice



    This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the co-sponsorship of The University of California Irvine's School of Medicine and ScientiaCME. The University of California Irvine's School of Medicine and ScientiaCME are accredited by the ACCME to provide continuing medical education for physicians.


    Credit Designation: The University of California, Irvine School of Medicine and ScientiaCME designate this educational activity for a maximum of .25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Release Date: June 13, 2012
    Expiration Date: July 01, 2013

    Faculty: Maxime Cannesson MD

    Faculty Disclosure and Resolution of COI:

    As an provider of continuing medical education, it is the policy of the UCI School of Medicine and ScientiaCME to ensure balance, independence, objectivity, and scientific rigor in all of its educational activities. In accordance with this policy, faculty and educational planners must disclose any significant relationships with commercial interests whose products or devices may be mentioned in faculty presentations, and any relationships with the commercial supporter of the activity. The intent of this disclosure is to provide the intended audience with information on which they can make their own judgments. Additionally, in the event a conflict of interest (COI) does exist, it is our policy to ensure that the COI is resolved in order to ensure the integrity of the CME activity. For this CME activity, any COI has been resolved thru content review by UCI School of Medicine and/or ScientiaCME.


    Faculty Disclosure: Maxime Cannesson, MD, PhD discloses being a consultant for Edwards Lifesciences, Masimo, and Covidien.


    Disclosures of Educational Planners:  Maxime Cannesson, MD, PhD discloses being a consultant for Edwards Lifesciences, Masimo, and Covidien.

    Viewing Requirements:



    Windows 2000 or above
    Internet Explorer 5.5
    Adobe Acrobat Reader*

    Mac OS 10.2.8
    Adobe Acrobat Reader*
    Internet Explorer is not supported on the Macintosh


    *Required to view Printable PDF Version



    -Read the learning objectives and faculty disclosures above

    -Take the Pre-Test (optional). Completion of the pre-test will help us evaluate the knowedge gained by participating in this CME activity.

    -View the on-line program. You may view this is in more than one session, and may pause or repeat any portion of the presentation if you need to.

    -Take the post-test

    -Complete the program evaluation and CME registration. A CE certificate will be emailed to you.

    Perform Pre-Test (optional)
    Please take a few minutes to participate in the optional pre-test. It will help us measure the knowledge gained by participating in this activity.


    View the on-line program


    Perform Post-Test

    Complete the Symposium Evaluation and Request CE Certificate

The 2nd Goal Directed Therpay Symposium was supported by grant funding from the following companies: BMEYE, Cardiotronic Osypka Medical, ConMed, Covidien, CNSystems, Edwards Lifesciences, Hospira, LiDCO, Masimo, and Tensys Medical. Adapting the live symposium to on-line programs was supported by grant funding from Edwards Lifesciences.