Current practice of hemodynamic monitoring and vasopressor and inotropic therapy in post-operative cardiac surgery patients in Germany: results from a postal survey.
BACKGROUND
In Germany, more than 100,000 patients are monitored and treated in 80 intensive care units (ICUs) following cardiac surgery each year. The controversies concerning the different methods of hemodynamic monitoring and the appropriate agents for volume therapy and inotropic support are well known. However, little is known about how monitoring and treatment are currently performed.


METHODS
A questionnaire with 39 questions was sent to the leading physicians of 80 ICUs in Germany, treating patients after cardiac surgery. The questions to be answered covered the current practice of hemodynamic monitoring, volume replacement, inotropic/vasopressor support and transfusions in patients after cardiac surgery.


RESULTS
Sixty-nine per cent of the questionnaires were completed and returned. All ICUs used basic monitoring as recommended by the societies. The use of advanced hemodynamic monitoring included the pulmonary artery catheter (58.2%), transesophageal echocardiography (38.1%) and transpulmonary dilution techniques (13%). Crystalloids (21.2%) and colloids (73%) were used for volume replacement. Epinephrine (41.8%) and dobutamine (30.9%) were the first-choice inotropic drugs for the treatment of low cardiac output syndrome, followed by phosphodiesterase inhibitors (14.5%). Second-choice drugs for the treatment of low cardiac output syndrome were enoximone (29%), milrinone (25%) and dobutamine (25%). A written transfusion protocol and a transfusion threshold for red blood cells existed in 59% and 79% of ICUs, respectively.


CONCLUSIONS
Hemodynamic monitoring and the variability in clinical practice with regard to volume replacement, transfusion triggers and the use of vasopressors/inotropes in cardiac surgery patients tend to follow the results of traditional experience rather than current scientific knowledge. Guidelines are therefore necessary to help to improve the standards of intensive care after cardiac surgery and thus the outcome of patients.
Kastrup
M
M
Department of Anesthesiology and Intensive Care Medicine, Charité--Universitätsmedizin Berlin, Berlin, Germany.
Markewitz
A
A
Spies
C
C
Carl
M
M
Erb
J
J
Grosse
J
J
Schirmer
U
U
D001803:Blood Transfusion / Q000592:standards; D002303:Cardiac Output, Low / Q000188:drug therapy; D006348:Cardiac Surgical Procedures; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D004837:Epinephrine / Q000627:therapeutic use*; D005858:Germany; D019538:Health Care Surveys; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use; D020896:Hypovolemia / Q000188:drug therapy; D008991:Monitoring, Physiologic / Q000379:methods / Q000706:statistics & numerical data; D011182:Postoperative Care; D017410:Practice Guidelines as Topic; D012709:Serum Albumin / Q000627:therapeutic use; D011795:Surveys and Questionnaires; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
D002316:Cardiotonic Agents; D006895:Hydroxyethyl Starch Derivatives; D012709:Serum Albumin; D014662:Vasoconstrictor Agents; D004837:Epinephrine