title: Monitoring dynamic arterial elastance as a means of decreasing the duration of norepinephrine treatment in vasoplegic syndrome following cardiac surgery: a prospective, randomized trial.
abstract: OBJECTIVE
  To evaluate the ability of an algorithm based on dynamic arterial elastance to decrease the duration of norepinephrine treatment.
  
  
  METHODS
  We performed a prospective, open-label, randomized study in patients requiring norepinephrine for vasoplegic syndrome after cardiac surgery with cardiopulmonary bypass. Patients were randomized to an algorithm-based intervention group or a control group. The primary outcome was the duration of norepinephrine treatment. The secondary outcomes included the total dose of norepinephrine, the length of stay (LOS) in the ICU, central venous oxygen saturation, arterial lactate levels, arrhythmia and diuresis.
  
  
  RESULTS
  Of 130 included patients, 118 were analysed on an intention-to-treat basis (intervention group: n = 59; control group: n = 59). On inclusion, the intervention and control groups did not differ significantly in terms of demographic characteristics, surgical data or the prior duration of norepinephrine treatment [5 h (4-10) vs. 5 h (5-7), respectively; P = 0.543]. The cumulative duration of norepinephrine treatment after inclusion was shorter in the intervention group than in the control group [17 h (13-26)] vs. 39 h (19-58), respectively; (P < 0.001). The cumulative dose of norepinephrine and the LOS in the ICU were also lower in the intervention group (P < 0.05). There were no intergroup differences for other outcomes (the sepsis-related organ failure score, central venous oxygen saturation, arrhythmia, and arterial lactate levels).
  
  
  CONCLUSIONS
  A haemodynamic algorithm based on dynamic arterial elastance was associated with a shorter duration of norepinephrine treatment and a shorter LOS in the ICU. Use of the algorithm did not alter perfusion parameters or increase the volume of fluid infused. ClinicalTrials.gov Identifier: NCT02479529.
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Amiens University Hospital, Place Victor Pauchet, 80054, Amiens, France. guinotpierregregoire@gmail.com.|INSERM U1088, Jules Verne University of Picardy, 80054, Amiens, France. guinotpierregregoire@gmail.com.
authors.forename: Pierre-Grégoire
authors.initials: PG
authors.lastname: Guinot
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Amiens University Hospital, Place Victor Pauchet, 80054, Amiens, France.
authors.forename: Osama
authors.initials: O
authors.lastname: Abou-Arab
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Amiens University Hospital, Place Victor Pauchet, 80054, Amiens, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Guilbart
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Amiens University Hospital, Place Victor Pauchet, 80054, Amiens, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Bar
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Amiens University Hospital, Place Victor Pauchet, 80054, Amiens, France.
authors.forename: Elie
authors.initials: E
authors.lastname: Zogheib
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Amiens University Hospital, Place Victor Pauchet, 80054, Amiens, France.
authors.forename: Mona
authors.initials: M
authors.lastname: Daher
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Amiens University Hospital, Place Victor Pauchet, 80054, Amiens, France.
authors.forename: Patricia
authors.initials: P
authors.lastname: Besserve
authors.affiliation: INSERM U1088, Jules Verne University of Picardy, 80054, Amiens, France.|Department of Cardiac Surgery, Amiens University Hospital, 80054, Amiens, France.
authors.forename: Joseph
authors.initials: J
authors.lastname: Nader
authors.affiliation: INSERM U1088, Jules Verne University of Picardy, 80054, Amiens, France.|Department of Cardiac Surgery, Amiens University Hospital, 80054, Amiens, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Caus
authors.affiliation: INSERM U1088, Jules Verne University of Picardy, 80054, Amiens, France.
authors.forename: Said
authors.initials: S
authors.lastname: Kamel
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Amiens University Hospital, Place Victor Pauchet, 80054, Amiens, France.|INSERM U1088, Jules Verne University of Picardy, 80054, Amiens, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Dupont
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, Amiens University Hospital, Place Victor Pauchet, 80054, Amiens, France.|INSERM U1088, Jules Verne University of Picardy, 80054, Amiens, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Lorne
mesh_terms: D000368:Aged; D000465:Algorithms; D001158:Arteries / Q000473:pathology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D016022:Case-Control Studies; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D057194:Intention to Treat Analysis; D019344:Lactic Acid / Q000097:blood; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000008:administration & dosage*; D011446:Prospective Studies; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*; D056987:Vasoplegia / Q000188:drug therapy*
chemical_list: D014662:Vasoconstrictor Agents; D019344:Lactic Acid; D009638:Norepinephrine
keywords: Dynamic arterial elastance; Norepinephrine; Vasoplegic syndrome