title: Catecholamine and volume therapy for cardiac surgery in Germany--results from a postal survey.
abstract: BACKGROUND
  Management of cardiac surgery patients is a very standardized procedure in respective local institutions. Yet only very limited evidence exists concerning optimal indication, safety and efficacy of hemodynamic monitoring catecholamine and fluid therapy.
  
  
  METHODS
  Between April and May 2013, all 81 German anaesthesia departments involved in cardiac surgery care were asked to participate in a questionnaire addressing the institutional specific current practice in hemodynamic monitoring, catecholamine and volume therapy.
  
  
  RESULTS
  51 (63%) questionnaires were completed and returned. All participating centers used basic hemodynamic monitoring (i.e. invasive arterial blood pressure and central venous pressure), supplemented by transesophageal echocardiography. Pulmonary arterial catheter and calibrated trend monitoring devices were also routinely available. In contrast, non-calibrated trend monitoring and esophageal doppler ultrasound devices were not commonly in use. Cerebral oximetry is increasingly emerging, but lacks clear indications. The majority of patients undergoing cardiac surgery, especially in university hospitals, required catecholamines during perioperative care, In case of low cardiac output syndrome, dobutamine (32%), epinephrine (30%) or phosphodiesterase inhibitors (8%) were first choice. In case of hypotension following vasoplegia, norepinephrine (96%) represented the most common catecholamine. 88% of the participating centers reported regular use of colloid fluids, with hydroxyethyl starches (HES) being first choice (64%).
  
  
  CONCLUSIONS
  Choice of hemodynamic monitoring is homogenous throughout German centers treating cardiac surgery patients. Norepinephrine is the first line catecholamine in cases of decrease in peripheral vascular resistance. However, catecholamine choice for low cardiac output syndrome varies considerably. HES was the primary colloid used for fluid resuscitation. After conduct of this survey, HES use was restricted by European regulatory authorities in critically ill patients and should only be considered as second-line fluid in surgical patients without renal impairment or severe coagulopathy. Large clinical studies addressing catecholamine and fluid therapy in cardiac surgery patients are lacking.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, University Hospital Jena, Jena, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Sponholz
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, University Hospital Jena, Jena, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schelenz
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, University Hospital Jena, Jena, Germany; Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany.
authors.forename: Konrad
authors.initials: K
authors.lastname: Reinhart
authors.affiliation: Institute of Anaesthesiology, Heart and Diabetes Center NRW, Ruhr University of Bochum, Bad Oeynhausen, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Schirmer
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, University Hospital Jena, Jena, Germany; Integrated Research and Treatment Center, Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany.
authors.forename: Sebastian N
authors.initials: SN
authors.lastname: Stehr
mesh_terms: D001794:Blood Pressure / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data*; D002315:Cardiopulmonary Bypass; D002395:Catecholamines / Q000494:pharmacology*; D005440:Fluid Therapy / Q000706:statistics & numerical data*; D005858:Germany / Q000453:epidemiology; D006306:Health Surveys; D006439:Hemodynamics / Q000187:drug effects; D006748:Hospital Departments / Q000706:statistics & numerical data; D006801:Humans; D007430:Intraoperative Care; D008991:Monitoring, Physiologic; D010477:Perfusion; D019990:Perioperative Care; D011177:Postal Service; D012307:Risk Factors; D013599:Systole / Q000187:drug effects
chemical_list: D002395:Catecholamines
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