Comparison of Goal-Directed Hemodynamic Optimization Using Pulmonary Artery Catheter and Autocalibrated Arterial Pressure Waveform Analysis Vigileo-FloTrac™ System in On-Pump Coronary Artery Bypass Graft Surgery: A Randomized Controlled Studya.

Abstract

Background:It is a challenge for anesthesiologists to balance between administering intravenous fluid, vasoactive agents, and inotropic drugs to maintain appropriate cardiac output.Aim:The aim of this study was to evaluate the effect of treatment algorithm guided either by pulmonary artery catheter (PAC) or by the fourth generation FloTrac/Vigileo system combined with monitoring of oxygen transport on hemodynamic management and outcome after coronary artery bypass graft surgery (CABG).Settings and Design:This study design was a prospective randomized controlled clinical study.Patients and Methods:Sixty patients aged 45–65 years, scheduled for CABG surgery for two or more grafts with cardiopulmonary bypass, were randomized into two groups 30 patients in each; (1) (Group P) patients in which PAC was inserted into internal jugular vein and connected to monitor. (2) (Group F) Patients in which arterial pressure catheter was inserted in radial artery and connected to the FloTrac sensor and Vigileo monitor.Statistical Analysis Used:Student's t-test or Mann–Whitney U-test and Chi-square or Fisher's exact tests were used.Results:Central venous pressure rose at the end of surgery in both groups and postoperatively declined transiently. Although the volume of crystalloids administered during surgery did not differ significantly between the groups, Group F received 24% more crystalloids and 3-fold more colloids postoperatively. Duration of postoperative respiratory support increased by 36% in Group P (P = 0.04).Conclusions:Goal-directed therapy based on pulse pressure analysis and oxygen transport increases the volume of fluid therapy, improves hemodynamics, and reduces the duration of respiratory support after CABG surgery.