Efficacy of Goal-Directed Therapy Using Bioreactance Cardiac Output Monitoring after Valvular Heart Surgery.
10.3349/ymj.2015.56.4.913
- Author:
Sak LEE
1
;
Seung Hyun LEE
;
Byung Chul CHANG
;
Jae Kwang SHIM
Author Information
1. Department of Thoracic and Cardiovascular Surgery, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
- Publication Type:Original Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
- Keywords:
Pulmonary artery catheterization;
goal directed therapy;
non-invasive cardiac output monitoring;
atrial fibrillation;
valvular heart surgery
- MeSH:
Aged;
Aged, 80 and over;
Cardiac Output/*physiology;
Cardiac Surgical Procedures/*methods;
Catheterization, Swan-Ganz;
Female;
Goals;
Heart Valves/*surgery;
Hemodynamics;
Humans;
Length of Stay/*statistics & numerical data;
Male;
Middle Aged;
Monitoring, Intraoperative/methods;
Monitoring, Physiologic/methods;
Postoperative Complications/epidemiology/prevention & control;
Postoperative Period
- From:Yonsei Medical Journal
2015;56(4):913-920
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: We compared the efficacy of postoperative hemodynamic goal-directed therapy (GDT) using a pulmonary artery catheter (PAC) and bioreactance-based noninvasive cardiac output monitoring (NICOM) in patients with atrial fibrillation undergoing valvular heart surgery. MATERIALS AND METHODS: Fifty eight patients were randomized into two groups of GDT with common goals to maintain a mean arterial pressure of 60-80 mm Hg and cardiac index > or =2 L/min/m2: the PAC group (n=29), based on pulmonary capillary wedge pressure, and the NICOM group (n=29), based on changes in stroke volume index after passive leg raising. The primary efficacy variable was length of hospital stay. Secondary efficacy variables included resource utilization including vasopressor and inotropic requirement, fluid balance, and major morbidity endpoints. RESULTS: Patient characteristics and operative data were similar between the groups, except that significantly more patients underwent double valve replacement in the NICOM group. The lengths of hospital stay were not different between the two groups (12.2+/-4.8 days vs. 10.8+/-4.0 days, p=0.239). Numbers of patients requiring epinephrine (5 vs. 0, p=0.019) and ventilator care >24 h (6 vs. 1, p=0.044) were significantly higher in the PAC group. The PAC group also required significantly larger amounts of colloid (1652+/-519 mL vs. 11430+/-463 mL, p=0.004). CONCLUSION: NICOM-based postoperative hemodynamic GDT showed promising results in patients with atrial fibrillation undergoing valvular heart surgery in terms of resource utilization.
