Goal-directed fluid management reduces vasopressor and catecholamine use in cardiac surgery patients
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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.
Forty cardiac bypass surgery patients were included prospectively and compared with a control group.
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.
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.
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.
KeywordsGoal-directed therapy Cardiac surgery Cardiac output Preload Global end-diastolic volume index
The authors thank the Ludwig Maximilian University Institute for Medical Data Processing, Biometry and Epidemiology for statistical support and calculation. D.A. R. a member of the Pulsion Medical Systems Medical Advisory Board and of a Medical Advisory Board of Fresenius-Kabi; he received a research grant from Pulsion Medical Systems which was not associated with the study submitted. A.E.G. is a member of the Pulsion Medical Systems Medical Advisory Board; he received no grants for this study but for experimental studies on functional hemodynamic monitoring in 1999–2000 (DM 40,000 from Pulsion Medical Systems, Germany) and no patents have been received with in relation to this study except for measurement of cerebral blood flow, together with Dr. Pfeiffer and Prof. Kübler. He personally received no payment with respect to this study; he received no additional honoraria except for travel reimbursements (from Abbott, Baxter, Fresenius Kabi, PMS).
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