Perfusión basada en objetivos: revisión integrativa sistemática.

Abstract

Goal-Directed Perfusion (GDP) represents a significant evolution in extracorporeal circulation through individualized perfusion support and continuous monitoring of critical physiological parameters. This integrative systematic review analyzes the historical evolution of GDP, its physiological basis, technological advances, and clinical outcomes in cardiac surgery. A literature search was performed in PubMed, ScienceDirect, Springer, ClinicalKey Student, and Google Scholar. Twenty-four studies were selected after critical analysis and screening. Findings show that GDP evolved from traditional flow and pressure-based models toward dynamic strategies using indexed oxygen delivery (DO₂i), indexed carbon dioxide production (VCO₂i), and venous oxygen saturation (SvO₂). Maintaining optimal DO₂i values was associated with reduced acute kidney injury, hyperlactatemia, and prolonged hospital stay. Advanced monitoring systems and artificial intelligence have improved individualized perfusion management. However, challenges related to protocol standardization, technological variability, and specialized training remain.