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Intensive Care Medicine

, Volume 33, Issue 1, pp 96–103 | Cite as

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. GoetzEmail author
Original

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 

Notes

Acknowledgements

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).

Supplementary material

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

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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
    Email author
  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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