title: Individually optimized hemodynamic therapy reduces complications and length of stay in the intensive care unit: a prospective, randomized controlled trial.
abstract: BACKGROUND
  The authors hypothesized that goal-directed hemodynamic therapy, based on the combination of functional and volumetric hemodynamic parameters, improves outcome in patients with cardiac surgery. Therefore, a therapy guided by stroke volume variation, individually optimized global end-diastolic volume index, cardiac index, and mean arterial pressure was compared with an algorithm based on mean arterial pressure and central venous pressure.
  
  
  METHODS
  This prospective, controlled, parallel-arm, open-label trial randomized 100 coronary artery bypass grafting and/or aortic valve replacement patients to a study group (SG; n = 50) or a control group (CG; n = 50). In the SG, hemodynamic therapy was guided by stroke volume variation, optimized global end-diastolic volume index, mean arterial pressure, and cardiac index. Optimized global end-diastolic volume index was defined before and after weaning from cardiopulmonary bypass and at intensive care unit (ICU) admission. Mean arterial pressure and central venous pressure served as hemodynamic goals in the CG. Therapy was started immediately after induction of anesthesia and continued until ICU discharge criteria, serving as primary outcome parameter, were fulfilled.
  
  
  RESULTS
  Intraoperative need for norepinephrine was decreased in the SG with a mean (±SD) of 9.0 ± 7.6 versus 14.9 ± 11.1 µg/kg (P = 0.002). Postoperative complications (SG, 40 vs. CG, 63; P = 0.004), time to reach ICU discharge criteria (SG, 15 ± 6 h; CG, 24 ± 29 h; P < 0.001), and length of ICU stay (SG, 42 ± 19 h; CG, 62 ± 58 h; P = 0.018) were reduced in the SG.
  
  
  CONCLUSIONS
  Early goal-directed hemodynamic therapy based on cardiac index, stroke volume variation, and optimized global end-diastolic volume index reduces complications and length of ICU stay after cardiac surgery.
authors.affiliation: * Senior Physician Anesthesiologist, † Anesthesiologist, § Resident, # Professor of Anesthesiology, Director, ** Professor of Anesthesiology, Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. ‡ Statistician, Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf. ‖ Professor of Cardiac Surgery, Director, Department of Cardiovascular Surgery, University Heart Center, University Medical Center Hamburg-Eppendorf.
authors.forename: Matthias S
authors.initials: MS
authors.lastname: Goepfert
authors.forename: Hans Peter
authors.initials: HP
authors.lastname: Richter
authors.forename: Christine
authors.initials: C
authors.lastname: Zu Eulenburg
authors.forename: Janna
authors.initials: J
authors.lastname: Gruetzmacher
authors.forename: Erik
authors.initials: E
authors.lastname: Rafflenbeul
authors.forename: Katharina
authors.initials: K
authors.lastname: Roeher
authors.forename: Alexandra
authors.initials: A
authors.lastname: von Sandersleben
authors.forename: Stefan
authors.initials: S
authors.lastname: Diedrichs
authors.forename: Herrmann
authors.initials: H
authors.lastname: Reichenspurner
authors.forename: Alwin E
authors.initials: AE
authors.lastname: Goetz
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Reuter
mesh_terms: D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use; D000368:Aged; D001021:Aortic Valve / Q000601:surgery; D062186:Arterial Pressure / Q000187:drug effects / Q000502:physiology; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002496:Central Venous Pressure / Q000187:drug effects / Q000502:physiology; D001026:Coronary Artery Bypass / Q000379:methods; D003971:Diastole / Q000187:drug effects / Q000502:physiology; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007552:Isotonic Solutions / Q000627:therapeutic use; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D010952:Plasma Substitutes / Q000627:therapeutic use; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D000077331:Ringer's Solution; D013318:Stroke Volume / Q000187:drug effects / Q000502:physiology
chemical_list: D000316:Adrenergic alpha-Agonists; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D000077331:Ringer's Solution; D004837:Epinephrine