A prospective, randomized study of goal-oriented hemodynamic therapy in cardiac surgical patients.
Organ dysfunction and multiple organ failure are the main causes of prolonged hospital stay after cardiac surgery, which increases resource use and health care costs. Increased levels of oxygen delivery and consumption are associated with improved outcome in different groups of postoperative patients. Cardiac surgical patients are at risk of inadequate perioperative oxygen delivery caused by extracorporeal circulation and limited cardiovascular reserves. The purpose of our study was to test whether increasing oxygen delivery immediately after cardiac surgery would shorten hospital and intensive care unit (ICU) stay. Four hundred three elective cardiac surgical patients were enrolled in the study and randomly assigned to either the control or the protocol group. Goals of the protocol group were to maintain SvO(2) >70% and lactate concentration < or =2.0 mmol/L from admission to the ICU and up to 8 h thereafter. Hemodynamics, oxygen transport data, and organ dysfunctions were recorded. The median hospital stay was shorter in the protocol group (6 vs 7 days, P < 0.05), and patients were discharged faster from the hospital than those in the control group (P < 0.05). Discharge from the ICU was similar between groups (P = 0. 8). Morbidity was less frequent at the time of hospital discharge in the protocol group (1.1% vs 6.1%, P < 0.01). Increasing oxygen delivery to achieve normal SvO(2) values and lactate concentration during the immediate postoperative period after cardiac surgery can shorten the length of hospital stay.


CONCLUSIONS
Health care economics has challenged clinicians to reduce costs and improve resource use in cardiac surgery and anesthesia in a patient population increasing in age and in severity of disease. Optimizing cardiovascular function to maintain adequate oxygen delivery during the immediate postoperative period after cardiac surgery can decrease morbidity and reduce length of hospital stay.
Pölönen
P
P
Critical Care Research Program, Departments of Anesthesia and Intensive Care, and Surgery, Kuopio University Hospital, Kuopio, Finland. pekka.polonen@kuh.fi
Ruokonen
E
E
Hippeläinen
M
M
Pöyhönen
M
M
Takala
J
J
D006348:Cardiac Surgical Procedures; D002316:Cardiotonic Agents / Q000008:administration & dosage; D004280:Dobutamine / Q000008:administration & dosage; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007262:Infusions, Intravenous; D007773:Lactates / Q000097:blood; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010100:Oxygen / Q000097:blood; D010101:Oxygen Consumption; D010952:Plasma Substitutes / Q000008:administration & dosage; D011182:Postoperative Care; D011183:Postoperative Complications; D011446:Prospective Studies
D002316:Cardiotonic Agents; D007773:Lactates; D010952:Plasma Substitutes; D004280:Dobutamine; D010100:Oxygen