Back to Search Start Over

Individually Optimized Hemodynamic Therapy Reduces Complications and Length of Stay in the Intensive Care Unit

Authors :
Hermann Reichenspurner
Alexandra von Sandersleben
Daniel A. Reuter
Christine Eulenburg
Matthias S. Goepfert
Janna Gruetzmacher
Alwin E. Goetz
Stefan Diedrichs
Erik Rafflenbeul
Katharina Roeher
Hans Peter Richter
Source :
Anesthesiology. 119:824-836
Publication Year :
2013
Publisher :
Ovid Technologies (Wolters Kluwer Health), 2013.

Abstract

Background:The authors hypothesized that goal-directed hemodynamic therapy, based on the combination of functional and volumetric hemodynamic parameters, improves outcome in patients with cardiac surgery. Therefore, a therapy guided by stroke volume variation, individually optimized global end-diastolic volume index, cardiac index, and mean arterial pressure was compared with an algorithm based on mean arterial pressure and central venous pressure.Methods:This prospective, controlled, parallel-arm, open-label trial randomized 100 coronary artery bypass grafting and/or aortic valve replacement patients to a study group (SG; n = 50) or a control group (CG; n = 50). In the SG, hemodynamic therapy was guided by stroke volume variation, optimized global end-diastolic volume index, mean arterial pressure, and cardiac index. Optimized global end-diastolic volume index was defined before and after weaning from cardiopulmonary bypass and at intensive care unit (ICU) admission. Mean arterial pressure and central venous pressure served as hemodynamic goals in the CG. Therapy was started immediately after induction of anesthesia and continued until ICU discharge criteria, serving as primary outcome parameter, were fulfilled.Results:Intraoperative need for norepinephrine was decreased in the SG with a mean (±SD) of 9.0 ± 7.6 versus 14.9 ± 11.1 µg/kg (P = 0.002). Postoperative complications (SG, 40 vs. CG, 63; P = 0.004), time to reach ICU discharge criteria (SG, 15 ± 6 h; CG, 24 ± 29 h; P < 0.001), and length of ICU stay (SG, 42 ± 19 h; CG, 62 ± 58 h; P = 0.018) were reduced in the SG.Conclusion:Early goal-directed hemodynamic therapy based on cardiac index, stroke volume variation, and optimized global end-diastolic volume index reduces complications and length of ICU stay after cardiac surgery.

Details

ISSN :
00033022
Volume :
119
Database :
OpenAIRE
Journal :
Anesthesiology
Accession number :
edsair.doi...........3913e6c7bec770737ecdaf05cec234bf
Full Text :
https://doi.org/10.1097/aln.0b013e31829bd770