Intensive Care Medicine

, Volume 33, Issue 1, pp 96–103

Goal-directed fluid management reduces vasopressor and catecholamine use in cardiac surgery patients

  • Matthias S. G. Goepfert
  • Daniel A. Reuter
  • Derya Akyol
  • Peter Lamm
  • Erich Kilger
  • Alwin E. Goetz
Original

DOI: 10.1007/s00134-006-0404-2

Cite this article as:
Goepfert, M.S.G., Reuter, D.A., Akyol, D. et al. Intensive Care Med (2007) 33: 96. doi:10.1007/s00134-006-0404-2

Abstract

Objective

We examined whether guiding therapy by an algorithm based on optimizing the global end-diastolic volume index (GEDVI) reduces the need for vasopressor and inotropic support and helps to shorten ICU stay in cardiac surgery patients.

Design and setting

Single-center clinical study with a historical control group at an university hospital.

Patients

Forty cardiac bypass surgery patients were included prospectively and compared with a control group.

Interventions

In the goal-directed therapy (GDT) group hemodynamic management was guided by an algorithm based on GEDVI. Hemodynamic goals were: GEDVI above 640 ml/m2, cardiac index above 2.5 l/min/m2, and mean arterial pressure above 70 mmHg. The control group was treated at the discretion of the attending physician based on central venous pressure, mean arterial pressure, and clinical evaluation.

Results

In the GDT group duration of catecholamine and vasopressor dependence was shorter (187 ± 70 vs. 1458 ± 197 min), and fewer vasopressors (0.73 ± 0.32 vs. 6.67 ± 1.21 mg) and catecholamines (0.01 ± 0.01 vs. 0.83 ± 0.27 mg) were administered. They received more colloids (6918 ± 242 vs. 5514 ± 171 ml). Duration of mechanical ventilation (12.6 ± 3.6 vs. 15.4 ± 4.3 h) and time until achieving status of fit for ICU discharge (25 ± 13 vs. 33 ± 17 h) was shorter in the GDT group.

Conclusions

Guiding therapy by an algorithm based on GEDVI leads to a shortened and reduced need for vasopressors, catecholamines, mechanical ventilation, and ICU therapy in patients undergoing cardiac surgery.

Keywords

Goal-directed therapy Cardiac surgery Cardiac output Preload Global end-diastolic volume index 

Supplementary material

134_2006_404_MOESM1_ESM.doc (54 kb)
Electronic Supplementary Material (DOC 70K)

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Matthias S. G. Goepfert
    • 1
    • 2
  • Daniel A. Reuter
    • 1
    • 2
  • Derya Akyol
    • 2
  • Peter Lamm
    • 3
  • Erich Kilger
    • 2
  • Alwin E. Goetz
    • 1
    • 2
  1. 1.Department of AnesthesiologyUniversity Medical Center Hamburg-EppendorfHamburgGermany
  2. 2.Department of AnesthesiologyUniversity of MunichMunichGermany
  3. 3.Department of Cardiac SurgeryUniversity of MunichMunichGermany

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