title: Post hoc analysis of the glutamics-trial: intravenous glutamate infusion and use of inotropic drugs after cabg.
abstract: Intravenous glutamate reduced the risk of developing severe circulatory failure after isolated coronary artery bypass graft surgery (CABG) for acute coronary syndrome (ACS) in a double-blind randomised clinical trial (GLUTAMICS-ClinicalTrials.gov Identifier: NCT00489827 ). Here our aim was to study if glutamate was associated with reduced the use of inotropes.
  
  
  
  Post-hoc analysis of 824 patients undergoing isolated CABG for ACS in the GLUTAMICS-trial. ICU-records were retrospectively scrutinised including hourly registration of inotropic drug infusion, dosage and total duration during the operation and postoperatively.
  
  
  
  ICU-records were found for 171 out of 177 patients who received inotropes perioperatively. Only one fourth of the patients treated with inotropes fulfilled study criteria for postoperative heart failure at weaning from cardiopulmonary bypass (CPB) or later in the ICU. Inotropes were mainly given preemptively to facilitate weaning from CPB or to treat postoperative circulatory instability (bleeding, hypovolaemia). Except for a significantly lower use of epinephrine there were only trends towards lower need of other inotropes overall in the glutamate group. In patients treated with inotropes (glutamate n = 17; placebo n = 13) who fulfilled study criteria for left ventricular failure at weaning from CPB the average duration of inotropic treatment (34 ± 20 v 80 ± 77 h; p = 0.014) and the number of inotropes used (1.35 ± 0.6 v 1.85 ± 0.7; p = 0.047) were lower in the glutamate group.
  
  
  
  Intravenous glutamate was associated with a minor influence on inotrope use overall in patients undergoing CABG for ACS whereas a considerable and significant reduction was observed in patients with heart failure at weaning from CPB.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
authors.forename: Mårten
authors.initials: M
authors.lastname: Vidlund
authors.affiliation: Department of Cardiothoracic Surgery and Cardiothoracic Anaesthesia, Faculty of Medicine and Health Sciences, Division of Cardiovascular Medicine, Linköping University, Linköping, Sweden.
authors.forename: Bashir
authors.initials: B
authors.lastname: Tajik
authors.affiliation: Department of Cardiothoracic Surgery and Cardiothoracic Anaesthesia, Faculty of Medicine and Health Sciences, Division of Cardiovascular Medicine, Linköping University, Linköping, Sweden.
authors.forename: Erik
authors.initials: E
authors.lastname: Håkanson
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
authors.forename: Örjan
authors.initials: Ö
authors.lastname: Friberg
authors.affiliation: Department of Cardiothoracic Surgery and Cardiothoracic Anaesthesia, Faculty of Medicine and Health Sciences, Division of Cardiovascular Medicine, Linköping University, Linköping, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Holm
authors.affiliation: Department of Cardiothoracic Surgery and Cardiothoracic Anaesthesia, Faculty of Medicine and Health Sciences, Division of Cardiovascular Medicine, Linköping University, Linköping, Sweden.
authors.forename: Farkas
authors.initials: F
authors.lastname: Vanky
authors.affiliation: Department of Cardiothoracic Surgery and Cardiothoracic Anaesthesia, Faculty of Medicine and Health Sciences, Division of Cardiovascular Medicine, Linköping University, Linköping, Sweden. rolf.svedjeholm@regionostergotland.se.
authors.forename: Rolf
authors.identifier: 0000-0002-9945-7486
authors.initials: R
authors.lastname: Svedjeholm
mesh_terms: D054058:Acute Coronary Syndrome / Q000601:surgery*; D000368:Aged; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D004311:Double-Blind Method; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D018698:Glutamic Acid / Q000008:administration & dosage*; D006333:Heart Failure / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy / Q000209:etiology
chemical_list: D002316:Cardiotonic Agents; D018698:Glutamic Acid; D004837:Epinephrine
keywords: Coronary artery bypass surgery; Epinephrine; Glutamate; Inotropic drugs; Intensive care; Milrinone; Postoperative complications