Abstract
Our aim was to compare the effects of goal-directed therapy guided either by pulmonary artery catheter (PAC) or by transpulmonary thermodilution (TTD) combined with monitoring of oxygen transport on perioperative hemodynamics and outcome after complex elective valve surgery. Measurements and Main Results. Forty patients were randomized into two equal groups: a PAC group and a TTD group. In the PAC group, therapy was guided by mean arterial pressure (MAP), cardiac index (CI) and pulmonary artery occlusion pressure (PAOP), whereas in the TTD group we additionally used global end-diastolic volume index (GEDVI), extravascular lung water index (EVLWI), and oxygen delivery index (DO2I). We observed a gradual increase in GEDVI, whereas EVLWI and PAOP decreased by 20–30% postoperatively (P < 0.05). The TTD group received 20% more fluid accompanied by increased stroke volume index and DO2I by 15–20% compared to the PAC group (P < 0.05). Duration of mechanical ventilation was increased by 5.2 hrs in the PAC group (P = 0.04). Conclusions. As compared to the PAC-guided algorithm, goal-directed therapy based on transpulmonary thermodilution and oxygen transport increases the volume of fluid therapy, improves hemodynamics and DO2I, and reduces the duration of respiratory support after complex valve surgery.
Highlights
Valve repair and replacement is a rapidly progressing and challenging type of cardiac surgery [1,2,3]
In the pulmonary artery catheter (PAC) group, therapy was guided by mean arterial pressure (MAP), cardiac index (CI) and pulmonary artery occlusion pressure (PAOP), whereas in the transpulmonary thermodilution (TTD) group we used global end-diastolic volume index (GEDVI), extravascular lung water index (EVLWI), and oxygen delivery index (DO2I)
In the TTD group, Central venous pressure (CVP) exceeded the corresponding values of the PAC group at 6 and 18 hrs (P < 0.05)
Summary
Valve repair and replacement is a rapidly progressing and challenging type of cardiac surgery [1,2,3]. The outcome of valve surgery is influenced by a variety of factors including age and the general condition of the patient, preoperative severity of heart dysfunction, myocardial ischemia, and duration of cardiopulmonary bypass (CPB) [4, 5] The latter may induce systemic inflammatory response syndrome (SIRS) and lead to multiorgan dysfunction syndrome (MODS) [6,7,8,9,10]. Socalled “less invasive” techniques for measurement of cardiac output (CO) have been implemented as a useful adjunct or even alternative to the hemodynamic monitoring by means of the pulmonary artery catheter (PAC). Transpulmonary thermodilution, allowing measurement of volumetric parameters and subsequent continuous, “beat-to-beat” CO-computation based on pulse
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