Hemodynamic and Oxygen Transport Monitoring During Myocardial Revascularization on the Working Heart

Abstract

Objective: to evaluate the impact of the algorithm based on a combination of transpulmonary dilution and continuous venous blood oxygen saturation monitoring on perioperative infusion therapy and hemodynamic correction and on the length of postoperative stay in an intensive care unit and at hospital after aortocoronary bypass surgery without extracorporeal circulation. Subjects and methods. The patients were randomized to two hemodynamic monitoring groups: 1) routine monitoring (RM) (n=20) and 2) complex monitoring (CM) (n=20). In the RM group, therapy was based on the values of central venous pressure, mean blood pressure (BPmean), and heart rate (HR). In the CM group, it was founded on the values of intrathoracic blood volume index, BPmean, HR, central venous saturation (ScvO2), and cardiac index (CI). Measurements were made before, during, and 2, 4, and 6 hours after surgery. Results. In the CM group, colloidal solutions and dobutamine were significantly more frequently used, which was followed by increases in ScvO2 and CI as compared with the baseline values. The frequency of use of ephedrine was significantly higher in the RM group. The algorithm based on complex monitoring reduced the time of achieving the criteria for transferring from the intensive care unit and the length of postoperative hospital stay by 15 and 25%, respectively. Conclusion. Thus, the goal-oriented algorithm based on the complex monitoring of hemodynamics and oxygen transport makes it possible to reveal hemodynamic disturbances and correct them early, which can improve an early postoperative period during aortocoronary bypass surgery on the working heart. Key words: aortocoronary bypass surgery, goal-oriented therapy, central venous saturation.