title: Multicenter trial of automated nitroprusside infusion for postoperative hypertension. Titrator Multicenter Study Group.
abstract: Hypertension is common after a cardiac operation and may result in postoperative hemorrhagic and other complications. Most often this problem has been treated using manually controlled doses of intravenous sodium nitroprusside. To evaluate the clinical impact of an automated closed-loop administration system on patients after cardiotomy, a prospective trial was conducted at nine clinical centers. Patients with hypertension were managed by either manual nitroprusside titration (n = 532) or a closed-loop automated titration system (n = 557). Patient groups were not significantly different in age, weight, or height. Moreover, the types of surgical procedures were comparable: primary coronary artery bypass grafting, 59.2% and 58.9%, manual group versus automated group; repeat coronary artery bypass grafting, 10.5% and 8.6%, respectively; valve procedures, 11.3% and 15.1%, respectively; and other cardiac procedures, 19.0% and 17.4%, respectively (all p = not significant). The automated group showed a significant reduction in the number of hypertensive episodes per patient (1.8 +/- 0.2 versus 0.6 +/- 0.07; p = 0.0001. At the same time, the number of hypotensive episodes per patient was reduced with automated closed-loop titration (0.40 +/- 0.05 versus 0.30 +/- 0.03; p = 0.02). Chest tube drainage (866 +/- 37 mL versus 693 +/- 23 mL [mean +/- standard error of the mean]; p = 0.0001), percentage of patients receiving transfusion (40.0% versus 33.0%; p = 0.02), and total amount transfused (2.4 +/- 0.12 units versus 2.0 +/- 0.10 units; p = 0.0003) were all reduced significantly by the use of an automated titration system.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Division of Cardiothoracic Surgery, East Carolina University School of Medicine, North Carolina 27858-4354.
authors.forename: W R
authors.initials: WR
authors.lastname: Chitwood
authors.forename: D M
authors.initials: DM
authors.lastname: Cosgrove
authors.forename: R M
authors.initials: RM
authors.lastname: Lust
mesh_terms: D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology; D007260:Infusion Pumps; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009599:Nitroprusside / Q000008:administration & dosage* / Q000009:adverse effects; D011183:Postoperative Complications / Q000188:drug therapy*; D011446:Prospective Studies; D012086:Reoperation
chemical_list: D009599:Nitroprusside