Goal-directed fluid management reduces vasopressor and catecholamine use in cardiac surgery patients.
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.
Goepfert
Matthias S G
MS
Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
Reuter
Daniel A
DA
Akyol
Derya
D
Lamm
Peter
P
Kilger
Erich
E
Goetz
Alwin E
AE
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*
D002395:Catecholamines; D014662:Vasoconstrictor Agents