Goal-directed fluid management reduces vasopressor and catecholamine use in cardiac surgery patients
Goal-directed fluid management reduces vasopressor and catecholamine use in cardiac surgery patients
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DOI：
10.1007/s00134-006-0404-2
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发表时间：
2007-01-01
影响因子：
38.9
通讯作者：
Goetz, Alwin E.
中科院分区：
文献类型：
--
作者：
Goepfert, Matthias S. G.;Reuter, Daniel A.;Goetz, Alwin E.
目的：我们研究了基于优化全球舒张末容量指数(GEDVI)的算法指导治疗是否减少了对血管升压剂和肌力支持的需求，并有助于缩短心脏手术患者在ICU的停留时间。设计和地点：一所大学医院的单中心临床研究，历史对照组。患者：前瞻性纳入40例心脏搭桥术患者，并与对照组进行比较。干预：在目标导向治疗(GDT)组，血流动力学管理由基于GEDVI的算法指导。血流动力学指标：GEDVI>640ml/m(2)，心脏指数>2.5 L/min/m(2)，平均动脉压>70 mm Hg。对照组由主治医生根据中心静脉压、平均动脉压和临床评估进行治疗。结果：GDT组儿茶酚胺和加压药依赖持续时间较短(187±/-70vs.1458±/-197min)，应用血管升压剂(0.73±/-0.32vs.6.67±1.21 mg)和儿茶酚胺(0.01+/-0.01vs.0.83+/-0.27 mg)较少。他们接受了更多的胶体(6918+/-242毫升对5514+/-171毫升)。GDT组机械通气时间(12.6±-3.6h比15.4+/-4.3h)和达到适合ICU出院状态的时间(25+/-13h比33+/-17h)更短。结论：通过基于GEDVI的算法指导治疗，可以缩短和减少心脏手术患者对血管加压剂、儿茶酚胺、机械通气和ICU治疗的需求。
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/m(2), cardiac index above 2.5 l/min/m(2), 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.