Effects of Advanced Hemodynamic Monitoring on the Postoperative Intubation Time in Patients With Moderate-to-Severe Left Ventricular Dysfunction Undergoing Cardiac Surgery

Document Type : Original Article

Authors

1 Cardiac Anesthesia Department, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

2 Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

Abstract

Background:Advanced monitoring can lead to the early recovery of patients in complicated and high-risk surgical operations. The aim of this study was to evaluate the effects of advanced monitoring on the hemodynamics of patients undergoing cardiac surgery.
 
Methods:In this study, patients undergoing cardiac surgery were divided into 2 groups of control and advanced monitoring. In each group, 25 patients were examined. The patients had moderate-to-severe left ventricular dysfunction (ejection fraction < 35%). The patients in the case group were placed on the FloTrac cardiac output monitor, which is used as a therapeutic guide in the operating room and the intensive care unit (ICU).
 
Results:Upon ICU admission, the average stroke volume variation and the mean cardiac index in the advanced monitoring group in the first 6 hours were 10 and 2.7, respectively, and in the second 6 hours were 11 and 2.8, correspondingly. The mean serum level administered was 1000 cc in the first 6 hours and 500 cc in the second 6 hours. In the control group, the mean serum level administered was 2000 cc in the first 6 hours and 500 cc in the second 6 hours, which had a significant relationship between the 2 groups in the first 6 hours (p = 0.01). Additionally, 84% of the patients with advanced monitoring were extubated in the first 6 hours (p = 0.0).
 
Conclusions: This study showed that cardiac surgery in patients with moderate-to-severe left ventricular dysfunction using advanced monitoring and goal-directed hemodynamic therapy based on the cardiac index, the stroke volume variation, and the stroke volume index reduced the duration of intubation after surgery. (Iranian Heart Journal 2020; 21(4): 25-32)
 

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References

  1. Shoemaker WC, Appel PL, Kram HB, Waxman K, Lee TS: Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest 1988;94:1176–86
  2. Algarni KD, Maganti M, YauTM. Predictors of low cardiac output syndrome after isolated coronary artery bypass surgery: Trends over 20 years. Ann Thorac Surg 2011; 92:1678–84.
  3. Rihal CS, NaiduSS, GivertzMM, etal. 2015 SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devicesin Cardiovascular Care: Endorsed by the American Heart Assocation, the Cardiological Society of India, and Sociedad Latino America. Jam Coll Cardio l2015; 65:e7–26.
  4. Landoni G, BoveT, Crivellari M, et al. Acuterenal failure after isolated CABG surgery: Sixy ears of experience. Minerva Anestesiol 2007; 73: 559–65.
  5. Aranki SF, ShawDP, AdamsDH, etal. Predictorsofatrial fibrillation after coronary artery surgery .Current trend sand impact on hospital resources. Circulation1996; 94:390–7.
  6. Vladimir V.Lomivorotov, MD, PhDn, SergeyM.Efremov, MD, PhDn, Mikhail Y.Kirov, MD, PhD, EvgenyV.Fominskiy, MD, PhDn, Alexander M.Karaskov, MD, PhD. Low-Cardiac-Output Syndrome After Cardiac Surgery, Journal of Cardiothoracic and Vascular Anesthesia 31(2017)291–308
  7. Hamilton MA, Cecconi M, Rhodes A: A systematic review and meta-analysis on the use of preemptive hemodynamic interventionTo improve postoperative outcomes in moderate andhigh-risk surgical patients. Anesth Analg 2011; 112:1392–402
  8. Mythen MG, Webb AR: Intra-operative gut mucosal hypoperfusion is associated with increased post-operative complicationsand cost. Intensive Care Med 1994; 20:99–4
  9. McKendry M, McGloin H, Saberi D, Caudwell L, Brady AR, Singer M: Randomised controlled trial assessing the impact of a nurse delivered, flow monitored protocol for optimisation of circulatory status after cardiac surgery. BMJ 2004; 329:258
  10. Matthias S. Goepfert, M.D.,* Hans Peter Richter, M.D., Christine zu Eulenburg, Sc.D., Janna Gruetzmacher, M.D., Erik Rafflenbeul, M.D., Katharina Roeher, M.D., Alexandra von Sandersleben, M.D., Stefan Diedrichs, M.D., Herrmann Reichenspurner, M.D., Ph.D, Alwin E. Goetz, M.D., Ph.D., Daniel A. Reuter, M.D., Ph.D. Individually Optimized Hemodynamic Therapy Reduces Complications and Length of Stay in the Intensive Care Unit. Anesthesiology 2013; 119:824-36.
  11. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M; Early Goal-Directed TherapyCollaborative Group: Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001;345:1368–77
  12. Goepfert MS, Reuter DA, Akyol D, Lamm P, Kilger E, Goetz AE: Goal-directed fluid management reduces vasopressor and catecholamine use in cardiac surgery patients. Intensive Care Med 2007; 33:96–3
  13. 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 randomised, controlled trial [ISRCTN38797445]. Crit Care 2005; 9:R687–93
  14. Kortgen A, Niederprüm P, Bauer M: Implementation of an evidence-based “standard operating procedure” and outcome in septic shock. Crit Care Med 2006; 34:943–9
  15. Jhanji S, Vivian-Smith A, Lucena-Amaro S, Watson D, Hinds CJ, Pearse RM: Haemodynamic optimisation improves tissuemicrovascular flow and oxygenation after major surgery: A randomised controlled trial. Crit Care 2010; 14:R151

 

Iranian Heart Journal
Volume 21, Issue 4
October 2020
Pages 14-21

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