Efficacy of Hemodynamic Monitoring in Cardiac Surgical
Patients Poramin Theanpramuk¹, Chawalit Wongbuddha¹, Bundit Mokarat¹
Affiliation : ¹ Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Background: Studies have shown that cardiac output-guided hemodynamic therapy reduces complications and length of hospital stay in the postoperative period. However, this strategy has variable effects in cardiac surgical patients at risk for low-cardiac-output syndrome (LCOS).
Objective: To compare the overall 30-day composite endpoint and hospital stay between conventional treatment (Group A) and cardiac outputguided hemodynamic therapy by institutional protocol (Group B) in postoperative cardiac surgical patients at risk for LCOS.
Materials and Methods: Sixty-five patients with 35 in Group A and 30 in Group B, that underwent coronary artery bypass surgery or valvular heart surgery between August 2018 and July 2019 were prospectively analyzed. In Group A, patients received standard protocol treatment guided primarily by mean arterial pressure and central venous pressure in the intensive care unit (ICU). In Group B, patients received treatment guided primarily by stroke volume variation, mean arterial pressure, and the cardiac index using the FloTrac monitoring system.
Results: The overall 30-day composite Group A and Group B endpoints were 62.9% and 46.7% (p=0.145), respectively. Group B had a lower occurrence of LCOS at 30% versus 37.1% (p=0.366), postoperative kidney injury at 20% versus 28.6% (p=0.424), and postoperative arrythmia at 20% versus 40% (p=0.082). Postoperative hemodialysis and postoperative mortality were higher in Group A at 5.7% versus 0% (p=0.184), and 2.9% versus 0% (p=0.351), respectively). Comparing both groups, there was no difference in length of ICU stay at 4 [3 to 5] versus 4 (2 to 5), (p=0.577) and hospital stay at 10 (9 to 130 versus 10 (9 to 11)(, p=0.201).
Conclusion: After cardiac surgery, cardiac output-guided hemodynamic therapy, compared to conventional treatment, insignificantly reduced the 30-day composite endpoint and length of hospital stay.
Received 22 September 2021 | Revised 24 January 2022 | Accepted 24 January 2022
DOI: 10.35755/jmedassocthai.2022.02.13270
Keywords : Low-cardiac-output syndrome; Cardiac output monitoring; Goal-directed therapy
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