Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Intensive Care Medicine
Published in: Intensive Care Medicine 1/2007

01-01-2007 | Original

Goal-directed fluid management reduces vasopressor and catecholamine use in cardiac surgery patients

Authors: Matthias S. G. Goepfert, Daniel A. Reuter, Derya Akyol, Peter Lamm, Erich Kilger, Alwin E. Goetz

Published in: Intensive Care Medicine | Issue 1/2007

Login to get access

Abstract

Objective

We examined whether guiding therapy by an algorithm based on optimizing the global end-diastolic volume index (GEDVI) reduces the need for vasopressor and inotropic support and helps to shorten ICU stay in cardiac surgery patients.

Design and setting

Single-center clinical study with a historical control group at an university hospital.

Patients

Forty cardiac bypass surgery patients were included prospectively and compared with a control group.

Interventions

In the goal-directed therapy (GDT) group hemodynamic management was guided by an algorithm based on GEDVI. Hemodynamic goals were: GEDVI above 640 ml/m2, cardiac index above 2.5 l/min/m2, and mean arterial pressure above 70 mmHg. The control group was treated at the discretion of the attending physician based on central venous pressure, mean arterial pressure, and clinical evaluation.

Results

In the GDT group duration of catecholamine and vasopressor dependence was shorter (187 ± 70 vs. 1458 ± 197 min), and fewer vasopressors (0.73 ± 0.32 vs. 6.67 ± 1.21 mg) and catecholamines (0.01 ± 0.01 vs. 0.83 ± 0.27 mg) were administered. They received more colloids (6918 ± 242 vs. 5514 ± 171 ml). Duration of mechanical ventilation (12.6 ± 3.6 vs. 15.4 ± 4.3 h) and time until achieving status of fit for ICU discharge (25 ± 13 vs. 33 ± 17 h) was shorter in the GDT group.

Conclusions

Guiding therapy by an algorithm based on GEDVI leads to a shortened and reduced need for vasopressors, catecholamines, mechanical ventilation, and ICU therapy in patients undergoing cardiac surgery.
Appendix
Available only for authorised users
Literature
1.
Michard F, Alaya S, Zarka V, Bahloul M, Richard C, Teboul JL (2003) Global end-diastolic volume as an indicator of cardiac preload in patients with septic shock. Chest 124:1900–1908PubMedCrossRef
2.
Michard F, Teboul JL (2002) Predicting fluid responsiveness in ICU patients: a critical analysis of the evidence. Chest 121:2000–2008PubMedCrossRef
3.
Christakis GT, Fremes SE, Naylor CD, Chen E, Rao V, Goldman BS (1996) Impact of preoperative risk and perioperative morbidity on ICU stay following coronary bypass surgery. Cardiovasc Surg 4:29–35PubMedCrossRef
4.
Ryan TA, Rady MY, Bashour CA, Leventhal M, Lytle B, Starr NJ (1997) Predictors of outcome in cardiac surgical patients with prolonged intensive care stay. Chest 112:1035–1042PubMed
5.
Weil J, Eschenhagen T, Hirt S, Magnussen O, Mittmann C, Remmers U, Scholz H (1998) Preserved Frank-Starling mechanism in human end stage heart failure. Cardiovasc Res 37:541–548PubMedCrossRef
6.
Lichtwarck-Aschoff M, Beale R, Pfeiffer UJ (1996) Central venous pressure, pulmonary artery occlusion pressure, intrathoracic blood volume, and right ventricular end-diastolic volume as indicators of cardiac preload. J Crit Care 11:180–188PubMedCrossRef
7.
Kumar A, Anel R, Bunnell E, Habet K, Zanotti S, Marshall S, Neumann A, Ali A, Cheang M, Kavinsky C, Parrillo JE (2004) Pulmonary artery occlusion pressure and central venous pressure fail to predict ventricular filling volume, cardiac performance, or the response to volume infusion in normal subjects. Crit Care Med 32:691–699PubMedCrossRef
8.
Bouchard MJ, Denault A, Couture P, Guertin MC, Babin D, Ouellet P, Carrier M, Tardif JC (2004) Poor correlation between hemodynamic and echocardiographic indexes of left ventricular performance in the operating room and intensive care unit. Crit Care Med 32:644–648PubMedCrossRef
9.
Brock H, Gabriel C, Bibl D, Necek S (2002) Monitoring intravascular volumes for postoperative volume therapy. Eur J Anaesthesiol 19:288–294PubMedCrossRef
10.
Reuter DA, Felbinger TW, Moerstedt K, Weis F, Schmidt C, Kilger E, Goetz AE (2002) Intrathoracic blood volume index measured by thermodilution for preload monitoring after cardiac surgery. J Cardiothorac Vasc Anesth 16:191–195PubMedCrossRef
11.
Reuter DA, Kirchner A, Felbinger TW, Weis FC, Kilger E, Lamm P, Goetz AE (2003) Usefulness of left ventricular stroke volume variation to assess fluid responsiveness in patients with reduced cardiac function. Crit Care Med 31:1399–1404PubMedCrossRef
12.
Katzenelson R, Perel A, Berkenstadt H, Preisman S, Kogan S, Sternik L, Segal E (2004) Accuracy of transpulmonary thermodilution versus gravimetric measurement of extravascular lung water. Crit Care Med 32:1550–1554PubMedCrossRef
13.
Fernandez-Mondejar E, Castano-Perez J, Rivera-Fernandez R, Colmenero-Ruiz M, Manzano F, Perez-Villares J, de la Chica R (2003) Quantification of lung water by transpulmonary thermodilution in normal and edematous lung. J Crit Care 18:253–258PubMedCrossRef
14.
Boussat S, Jacques T, Levy B, Laurent E, Gache A, Capellier G, Neidhardt A (2002) Intravascular volume monitoring and extravascular lung water in septic patients with pulmonary edema. Intensive Care Med 28:712–718PubMedCrossRef
15.
Sakka SG, Ruhl CC, Pfeiffer UJ, Beale R, McLuckie A, Reinhart K, Meier-Hellmann A (2000) Assessment of cardiac preload and extravascular lung water by single transpulmonary thermodilution. Intensive Care Med 26:180–187PubMedCrossRef
16.
Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M Early Goal-Directed Therapy Collaborative Group (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345:1368–1377PubMedCrossRef
17.
Gan TJ, Soppitt A, Maroof M, el-Moalem H, Robertson KM, Moretti E, Dwane P, Glass PS (2002) Goal-directed intraoperative fluid administration reduces length of hospital stay after major surgery. Anesthesiology 97:820–826PubMedCrossRef
18.
Polonen P, Ruokonen E, Hippelainen M, Poyhonen M, Takala J (2000) A prospective, randomized study of goal-oriented hemodynamic therapy in cardiac surgical patients. Anesth Analg 90:1052–1059PubMedCrossRef
19.
Goepfert MSG, Reuter DA, Akyol D, Kilger E, Goetz AE (2004) Volume management by goal directed therapy reduces catecholamine-need in cardiosurgery patients (abstract) Crit Care Med 30[Suppl 1]:588130
20.
Combes A, Berneau JB, Luyt CE, Trouillet JL (2004) Estimation of left ventricular systolic function by single transpulmonary thermodilution. Intensive Care Med 30:1377–1383PubMed
21.
Sakka SG, Bredle DL, Reinhart K, Meier-Hellmann A (1999) Comparison between intrathoracic blood volume and cardiac filling pressures in the early phase of hemodynamic instability of patients with sepsis or septic shock. J Crit Care 14:78–83PubMedCrossRef
22.
Sakka SG, Klein M, Reinhart K, Meier-Hellmann A (2002) Prognostic value of extravascular lung water in critically ill patients. Chest 122:2080–2086PubMedCrossRef
23.
Cheng DC, Newman MF, Duke P, Wong DT, Finegan B, Howie M, Fitch J, Bowdle TA, Hogue C, Hillel Z, Pierce E, Bukenya D (2001) The efficacy and resource utilization of remifentanil and fentanyl in fast-track coronary artery bypass graft surgery: a prospective randomized, double-blinded controlled, multi-center trial. Anesth Analg 92:1094–1102PubMedCrossRef
24.
Mythen MG, Webb AR (1994) Intra-operative gut mucosal hypoperfusion is associated with increased post-operative complications and cost. Intensive Care Med 20:99–104PubMedCrossRef
25.
Shoemaker WC, Thangathurai D, Wo CC, Kuchta K, Canas M, Sullivan MJ, Farlo J, Roffey P, Zellman V, Katz RL (1999) Intraoperative evaluation of tissue perfusion in high-risk patients by invasive and noninvasive hemodynamic monitoring. Crit Care Med 27:2147–2152PubMedCrossRef
26.
Maillet JM, Le Besnerais P, Cantoni M, Nataf P, Ruffenach A, Lessana A, Brodaty D (2003) Frequency, risk factors, and outcome of hyperlactatemia after cardiac surgery. Chest 123:1361–1366PubMedCrossRef
27.
Shoemaker WC, Patil R, Appel PL, Kram HB (1992) Hemodynamic and oxygen transport patterns for outcome prediction, therapeutic goals, and clinical algorithms to improve outcome. Feasibility of artificial intelligence to customize algorithms. Chest 102:617S–625S
28.
Kern JW, Shoemaker WC (2002) Meta-analysis of hemodynamic optimization in high-risk patients. Crit Care Med 30:1686–1692PubMedCrossRef
29.
Shoemaker WC, Appel PL, Kram HB, Waxman K, Lee TS (1988) Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest 94:1176–1186PubMed
30.
McKendry M, McGloin H, Saberi D, Caudwell L, Brady AR, Singer M (2004) Randomised controlled trial assessing the impact of a nurse delivered, flow monitored protocol for optimisation of circulatory status after cardiac surgery. BMJ 329:258–262PubMedCrossRef
31.
Schmidlin D, Schuepbach R, Bernard E, Ecknauer E, Jenni R, Schmid ER (2001) Indications and impact of postoperative transesophageal echocardiography in cardiac surgical patients. Crit Care Med 29:2143–2148PubMedCrossRef
32.
Boldt J, Ducke M, Kumle B, Papsdorf M, Zurmeyer EL (2004) Influence of different volume replacement strategies on inflammation and endothelial activation in the elderly undergoing major abdominal surgery. Intensive Care Med 30:416–422PubMedCrossRef
33.
34.
Wilson J, Woods I, Fawcett J, Whall R, Dibb W, Morris C, McManus E (1999) Reducing the risk of major elective surgery: randomised controlled trial of preoperative optimisation of oxygen delivery. BMJ 318:1099–1103PubMed
Metadata
Title
Goal-directed fluid management reduces vasopressor and catecholamine use in cardiac surgery patients
Authors
Matthias S. G. Goepfert
Daniel A. Reuter
Derya Akyol
Peter Lamm
Erich Kilger
Alwin E. Goetz
Publication date
01-01-2007
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 1/2007
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-006-0404-2

Other articles of this Issue 1/2007

Intensive Care Medicine 1/2007 Go to the issue

Original

Postresuscitation myocardial dysfunction: correlated factors and prognostic implications

Review

Intestinal motility disturbances in intensive care patients pathogenesis and clinical impact

Editorial

Electroencephalography: the worst traditionally recommended tool for brain death confirmation

Erratum

The “Lund Concept” for the treatment of severe head trauma – physiological principles and clinical application

Original

Remifentanil-based sedation to treat noninvasive ventilation failure: a preliminary study

Mini series: Basic research-related topics in ICM

Lipoproteins in inflammation and sepsis. I. Basic science