title: Goal-directed fluid management reduces vasopressor and catecholamine use in cardiac surgery patients.
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.
  
  
  METHODS
  Single-center clinical study with a historical control group at an university hospital.
  
  
  METHODS
  Forty cardiac bypass surgery patients were included prospectively and compared with a control group.
  
  
  METHODS
  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+/-0.27mg) were administered. They received more colloids (6918+/-242 vs. 5514+/-171ml). 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+/-17h) 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.
authors.affiliation: Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Matthias S G
authors.initials: MS
authors.lastname: Goepfert
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Reuter
authors.forename: Derya
authors.initials: D
authors.lastname: Akyol
authors.forename: Peter
authors.initials: P
authors.lastname: Lamm
authors.forename: Erich
authors.initials: E
authors.lastname: Kilger
authors.forename: Alwin E
authors.initials: AE
authors.lastname: Goetz
mesh_terms: D000465:Algorithms; D001794:Blood Pressure; D006348:Cardiac Surgical Procedures; D002395:Catecholamines / Q000627:therapeutic use*; D003422:Critical Care / Q000706:statistics & numerical data*; D003971:Diastole; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D002395:Catecholamines; D014662:Vasoconstrictor Agents