Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Volume  28 (2024)
Volume  27 (2023)
Volume  26 (2022)
Volume  25 (2021)
Volume  24 (2020)
Volume  23 (2019)
Volume  22 (2018)
Volume  21 (2017)
Volume  20 (2016)
Volume  19 (2015)
Volume  18 (2014)
Volume  17 (2013)
Volume  16 (2012)
Volume  15 (2011)
Volume  14 (2010)
Volume  13 (2009)
Volume  12 (2008)
Volume  11 (2007)
Volume  10 (2006)
Volume  9 (2005)
Volume  8 (2004)
Related articles

VOLUME 24 , ISSUE 5 ( May, 2020 ) > List of Articles

ORIGINAL RESEARCH ARTICLE

Effect of Goal-directed Hemodynamic Therapy in Postcardiac Surgery Patients

Hasmukh Patel, Nirav Parikh, Ritesh Shah, Ramesh Patel, Rajesh Thosani, Pratik Shah, Lokesh Prajapat

Keywords : Acute kidney injury, Cardiopulmonary bypass, Early goal-directed therapy

Citation Information : Patel H, Parikh N, Shah R, Patel R, Thosani R, Shah P, Prajapat L. Effect of Goal-directed Hemodynamic Therapy in Postcardiac Surgery Patients. Indian J Crit Care Med 2020; 24 (5):321-326.

DOI: 10.5005/jp-journals-10071-23427

License: CC BY-NC 4.0

Published Online: 28-07-2020

Copyright Statement:  Copyright © 2020; The Author(s).


Abstract

Background and aims: Early goal-directed therapy (EGDT) provides preset goals to be achieved by intravenous fluid therapy and inotropic therapy with earliest detection of change in the hemodynamic profile. Improved outcome in cardiac surgery patients has been shown by perioperative volume optimization, while postoperative intensive care unit (ICU) stay can be decreased by improving oxygen delivery. Our aim of this study was to study the outcome of EGDT in patients undergoing elective cardiac surgery. Materials and methods: This is a prospective single institute study involving a total of 478 patients. Patients were divided into group I, who received standard hospital care, and group II, who received EGDT. Postoperatively, patients were observed in ICU for 72 hours. Hemodynamics, laboratory data, fluid bolus, inotrope score, complication, ventilatory time, and mortality data were collected. Results: Postoperative ventilatory period (11.12 ± 10.11 vs 9.45 ± 8.87, p = 0.0719) and frequency of change in inotropes (1.900 ± 0.9 vs 1.19 ± 0.61, p = 0.0717) were lower in group II. Frequency of crystalloid boluses (1.33 ± 0.65 vs 1.75 ± 1.09, p = 0.0126), and quantity of packed cell volume (PCV) used (1.63 ± 1.03 vs 2.04 ± 1.42, p = 0.0364) were highly significant in group II. Use of colloids was higher in group II and was statistically significant (1.98 ± 1.99 vs 3.05 ± 2.17, p = 0.0012). The acute kidney injury (AKI) rate was (58 (23.10%) vs 30 (13.21%), p = 0.007) lower and statistically significant (p = 0.007) in group II. Conclusion: Early goal-directed therapy reduces the postoperative ventilatory period, frequency of changes in inotropes, and incidence of AKI, and decreases ventilation hours, number of times inotropes changed, and AKI.

HTML PDF Share
  1. Higgins TL, Yared JP, Ryan T. Immediate postoperative care of cardiac surgical patients. J Cardiothorac Vasc Anesth 1996;10(5):643–658. DOI: 10.1016/S1053-0770(96)80145-5.
  2. Ryan TA, Rady MY, Bashour CA, Leventhal M, Lytle B, Starr NJ. Predictors of outcome in cardiac surgical patients with prolonged intensive care stay. Chest 1997;112(4):1035–1042. DOI: 10.1378/chest.112.4.1035.
  3. Warner CD, Weintraub WS, Craver JM, Jones EL, Gott JP, Guyton RA. Effect of cardiac surgery patient characteristics on patient outcomes from 1981 through 1995. Circulation 1997;96(5):1575–1579. DOI: 10.1161/01.CIR.96.5.1575.
  4. Shoemaker WC, Appel PL, Waxman K, Schwartz S, Chang P. Clinical trial of survivors’ cardiorespiratory patterns as therapeutic goals in critically ill postoperative patients. Crit Care Med 1982;10(6):398–403. DOI: 10.1097/00003246-198206000-00015.
  5. Bland R, Shoemaker WC, Shabot MM. Physiologic monitoring goals for the critically ill patient. Surg Gynecol Obstet 1978;147(6): 833–841.
  6. Beal AL, Cerra FB. Multiple organ failure syndrome in the 1990s: systemic inflammatory response and organ dysfunction. JAMA 1994;271(3):226–233. DOI: 10.1001/jama.1994.03510270072043.
  7. Pearse R, Dawson D, Fawcett J, Rhodes A, Grounds RM, Bennett ED. Early goal-directed therapy after major surgery reduces complications and duration of hospital stay: a randomized controlled trial. Crit Care 2005;9(6):R687–R693. DOI: 10.1186/cc3887.
  8. Mythen MG, Webb AR. Perioperative plasma volume expansion reduces the incidence of gut mucosal hypoperfusion during cardiac surgery. Arch Surg 1995;130(4):423–429. DOI: 10.1001/archsurg.1995.01430040085019.
  9. Khwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract 2012;120(4):c179–c184. DOI: 10.1159/000339789.
  10. Nashef SA, Roques F, Michel P, Gauducheau E, Lemeshow S, Salamon R. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg 1999;16((1):9–13. DOI: 10.1016/S1010-7940(99)00134-7.
  11. Polonen P, Ruokonen E, Hippelainen M, Poyhonen M, Takala J. A prospective, randomized study of goal-oriented haemodynamic therapy in cardiac surgical patients. Anesth Analg 2000;90(5): 1052–1059. DOI: 10.1097/00000539-200005000-00010.
  12. Routsi C, Vincent JL, Bakker J, De Backer D, et al. Relation between oxygen consumption and oxygen delivery in patients after cardiac surgery. Anesth Analg 1993;77(6):1104–1110. DOI: 10.1213/00000539-199312000-00004.
  13. Aya HD, Cecconi M, Hamilton M, Rhodes A. Goal-directed therapy in cardiac surgery: a systematic review and meta-analysis. Br J Anaesth 2013;110(4):510–517. DOI: 10.1093/bja/aet020.
  14. Kapoor PM, Magoon R, Rawat RS, Mehta Y, et al. Goal-directed therapy improves the outcome of high-risk cardiac patients undergoing off-pump coronary artery bypass. Ann Card Anaesth 2017;20(1):83. DOI: 10.4103/0971-9784.197842.
  15. Goldman RH, Klughaupt M, Metcalf T, Spivack AP, Harrison DC. Measurement of central venous oxygen saturation in patients with myocardial infarction. Circulation 1968;38(5):941–946. DOI: 10.1161/01.CIR.38.5.941.
  16. Wakeling HG, McFall MR, Jenkins CS, Woods WG, et al. Intraoperative oesophageal Doppler guided fluid management shortens postoperative hospital stay after major bowel surgery. Br J Anaesth 2005;95(5):634–642. DOI: 10.1093/bja/aei223.
  17. Gan TJ, Soppitt A, Maroof M, el-Moalem H, et al. Goal-directed intraoperative fluid administration reduces length of hospital stay after major surgery. Anesthesiology 2002;97(4):820–826. DOI: 10.1097/00000542-200210000-00012.
  18. Manecke Jr GR, Auger WR. Cardiac output determination from the arterial pressure wave: clinical testing of a novel algorithm that does not require calibration. J Cardiothorac Vasc Anesth 2007;21(1):3–7. DOI: 10.1053/j.jvca.2006.08.004.
  19. McGee WT, Horswell JL, Calderon J, Janvier G, et al. Validation of a continuous, arterial pressure based cardiac output measurement: a multicenter, prospective clinical trial. Crit Care 2007;11(5):R105. DOI: 10.1186/cc6125.
  20. Chakravarthy M, Patil TA, Jayaprakash K, Kalligudd P, Prabhakumar D, Jawali V. Comparison of simultaneous estimation of cardiac output by four techniques in patients undergoing off pump coronary artery bypass surgery: a prospective observational study. Ann Card Anaesth 2007;10(2):121–126. DOI: 10.4103/0971-9784. 37937.
  21. Opdam HI, Wan L, Bellomo R. A pilot assessment of the FloTrac cardiac output monitoring system. Intensive Care Med 2007;33(2):344–349. DOI: 10.1007/s00134-006-0410-4.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.