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Monitoring dynamic arterial elastance as a means of decreasing the duration of norepinephrine treatment in vasoplegic syndrome following cardiac surgery: a prospective, randomized trial

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Abstract

Purpose

To evaluate the ability of an algorithm based on dynamic arterial elastance to decrease the duration of norepinephrine treatment.

Methods

We performed a prospective, open-label, randomized study in patients requiring norepinephrine for vasoplegic syndrome after cardiac surgery with cardiopulmonary bypass. Patients were randomized to an algorithm-based intervention group or a control group. The primary outcome was the duration of norepinephrine treatment. The secondary outcomes included the total dose of norepinephrine, the length of stay (LOS) in the ICU, central venous oxygen saturation, arterial lactate levels, arrhythmia and diuresis.

Results

Of 130 included patients, 118 were analysed on an intention-to-treat basis (intervention group: n = 59; control group: n = 59). On inclusion, the intervention and control groups did not differ significantly in terms of demographic characteristics, surgical data or the prior duration of norepinephrine treatment [5 h (4–10) vs. 5 h (5–7), respectively; P = 0.543]. The cumulative duration of norepinephrine treatment after inclusion was shorter in the intervention group than in the control group [17 h (13–26)] vs. 39 h (19–58), respectively; (P < 0.001). The cumulative dose of norepinephrine and the LOS in the ICU were also lower in the intervention group (P < 0.05). There were no intergroup differences for other outcomes (the sepsis-related organ failure score, central venous oxygen saturation, arrhythmia, and arterial lactate levels).

Conclusion

A haemodynamic algorithm based on dynamic arterial elastance was associated with a shorter duration of norepinephrine treatment and a shorter LOS in the ICU. Use of the algorithm did not alter perfusion parameters or increase the volume of fluid infused.

ClinicalTrials.gov Identifier: NCT02479529.

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Authors and Affiliations

  1. Department of Anaesthesiology and Critical Care Medicine, Amiens University Hospital, Place Victor Pauchet, 80054, Amiens, France

    Pierre-Grégoire Guinot, Osama Abou-Arab, Mathieu Guilbart, Stéphane Bar, Elie Zogheib, Mona Daher, Patricia Besserve, Hervé Dupont & Emmanuel Lorne

  2. INSERM U1088, Jules Verne University of Picardy, 80054, Amiens, France

    Pierre-Grégoire Guinot, Joseph Nader, Thierry Caus, Said Kamel, Hervé Dupont & Emmanuel Lorne

  3. Department of Cardiac Surgery, Amiens University Hospital, 80054, Amiens, France

    Joseph Nader & Thierry Caus

Authors
  1. Pierre-Grégoire Guinot
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  2. Osama Abou-Arab
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  3. Mathieu Guilbart
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  4. Stéphane Bar
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  5. Elie Zogheib
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  6. Mona Daher
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  7. Patricia Besserve
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  8. Joseph Nader
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  9. Thierry Caus
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  10. Said Kamel
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  11. Hervé Dupont
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  12. Emmanuel Lorne
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Corresponding author

Correspondence to Pierre-Grégoire Guinot.

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Conflicts of interests

The authors declare that they have no competing interests.

Funding

No external funding was received. The study received no specific financial support.

Additional information

Take-home message: In cardiac surgery patients suffering from vasoplegic syndrome, the use of an algorithm based on dynamic arterial elastance was associated with a shorter duration of norepinephrine treatment and a shorter LOS in the ICU. This difference did not alter perfusion parameters or fluid requirements.

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Guinot, PG., Abou-Arab, O., Guilbart, M. et al. Monitoring dynamic arterial elastance as a means of decreasing the duration of norepinephrine treatment in vasoplegic syndrome following cardiac surgery: a prospective, randomized trial. Intensive Care Med 43, 643–651 (2017). https://doi.org/10.1007/s00134-016-4666-z

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  • DOI: https://doi.org/10.1007/s00134-016-4666-z

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