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.
Highlights
ĐĄĐ”ĐČĐ”ŃĐœŃĐč ĐłĐŸŃŃĐŽĐ°ŃŃŃĐČĐ”ĐœĐœŃĐč ĐŒĐ”ĐŽĐžŃĐžĐœŃĐșĐžĐč ŃĐœĐžĐČĐ”ŃŃĐžŃĐ”Ń, ĐșĐ°ŃДЎŃĐ° Đ°ĐœĐ”ŃŃĐ”Đ·ĐžĐŸĐ»ĐŸĐłĐžĐž Đž ŃĐ”Đ°ĐœĐžĐŒĐ°ŃĐŸĐ»ĐŸĐłĐžĐž, ĐŃĐŽĐ”Đ»Đ”ĐœĐžĐ” Đ°ĐœĐ”ŃŃĐ”Đ·ĐžĐŸĐ»ĐŸĐłĐžĐž, ŃĐ”Đ°ĐœĐžĐŒĐ°ŃĐŸĐ»ĐŸĐłĐžĐž Đž ĐžĐœŃĐ”ĐœŃĐžĐČĐœĐŸĐč ŃĐ”ŃапОО, ĐĐŁĐ ĐĐ”ŃĐČĐ°Ń ĐłĐŸŃĐŸĐŽŃĐșĐ°Ń ĐșĐ»ĐžĐœĐžŃĐ”ŃĐșĐ°Ń Đ±ĐŸĐ»ŃĐœĐžŃĐ° ŃĐșĐŸŃĐŸĐč ĐŒĐ”ĐŽĐžŃĐžĐœŃĐșĐŸĐč ĐżĐŸĐŒĐŸŃĐž, ĐŃŃ Đ°ĐœĐłĐ”Đ»ŃŃĐș
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
The patients were randomized to two hemodynamic monitoring groups: 1) routine monitoring (RM) (n=20) and 2) complex monitoring (CM) (n=20)
Summary
ĐŠĐ”Đ»Ń ĐžŃŃĐ»Đ”ĐŽĐŸĐČĐ°ĐœĐžŃ â ĐŸŃĐ”ĐœĐžŃŃ ĐČлОŃĐœĐžĐ” Đ°Đ»ĐłĐŸŃĐžŃĐŒĐ°, ĐŸŃĐœĐŸĐČĐ°ĐœĐœĐŸĐłĐŸ ĐœĐ° ĐșĐŸĐŒĐ±ĐžĐœĐ°ŃОО ŃŃĐ°ĐœŃĐżŃĐ»ŃĐŒĐŸĐœĐ°Đ»ŃĐœĐŸĐč ŃĐ”ŃĐŒĐŸĐŽĐžĐ»ŃŃОО Đž ĐœĐ”ĐżŃĐ”ŃŃĐČĐœĐŸĐłĐŸ ĐŒĐŸĐœĐžŃĐŸŃĐžĐœĐłĐ° ĐœĐ°ŃŃŃĐ”ĐœĐžŃ ĐČĐ”ĐœĐŸĐ·ĐœĐŸĐč ĐșŃĐŸĐČĐž ĐșĐžŃĐ»ĐŸŃĐŸĐŽĐŸĐŒ, ĐœĐ° пДŃĐžĐŸĐżĐ”ŃĐ°ŃĐžĐŸĐœĐœŃŃ ĐžĐœŃŃĐ·ĐžĐŸĐœĐœŃŃ ŃĐ”ŃĐ°ĐżĐžŃ Đž ĐșĐŸŃŃĐ”ĐșŃĐžŃ ĐłĐ”ĐŒĐŸĐŽĐžĐœĐ°ĐŒĐžĐșĐž, Đ° ŃĐ°ĐșжД ĐœĐ° ĐżŃĐŸĐŽĐŸĐ»Đ¶ĐžŃДлŃĐœĐŸŃŃŃ ĐżĐŸŃĐ»Đ”ĐŸĐżĐ”ŃĐ°ŃĐžĐŸĐœĐœĐŸĐłĐŸ ĐżŃДбŃĐČĐ°ĐœĐžŃ ĐČ ĐŸŃĐŽĐ”Đ»Đ”ĐœĐžĐž ĐžĐœŃĐ”ĐœŃĐžĐČĐœĐŸĐč ŃĐ”ŃапОО Đž ŃŃĐ°ŃĐžĐŸĐœĐ°ŃĐ” ĐżŃĐž Đ°ĐŸŃŃĐŸĐșĐŸŃĐŸĐœĐ°ŃĐœĐŸĐŒ ŃŃĐœŃĐžŃĐŸĐČĐ°ĐœĐžĐž бДз ĐžŃĐșŃŃŃŃĐČĐ”ĐœĐœĐŸĐłĐŸ ĐșŃĐŸĐČĐŸĐŸĐ±ŃĐ°ŃĐ”ĐœĐžŃ. ĐŃĐ” ĐŸĐŽĐœĐžĐŒ ĐœĐ°ĐżŃĐ°ĐČĐ»Đ”ĐœĐž Đ”ĐŒ ĐŒĐŸĐœĐžŃĐŸŃĐžĐœĐłĐ° ĐżŃĐž ĐĐĐš бДз ĐĐ ŃĐČĐ»ŃĐ”ŃŃŃ ŃĐ°ĐœĐœĐ”Đ” ĐČŃŃĐČ Đ»Đ”ĐœĐžĐ” ŃĐșĐ°ĐœĐ”ĐČĐŸĐč ĐłĐžĐżĐŸĐșŃОО, ĐșĐŸŃĐŸŃĐ°Ń ĐŒĐŸĐ¶Đ”Ń ŃĐŸŃ ŃĐ°ĐœŃŃŃŃŃ, ĐœĐ”ŃĐŒĐŸŃŃŃ ĐœĐ° ĐœĐŸŃĐŒĐ°Đ»ŃĐœŃĐ” Đ·ĐœĐ°ŃĐ”ĐœĐžŃ ŃŃĐ”ĐŽĐœĐ”ĐłĐŸ Đ°ŃŃĐ”ŃĐžĐ°Đ»Ń ĐœĐŸĐłĐŸ ĐŽĐ°ĐČĐ»Đ”ĐœĐžŃ (ĐĄŃĐĐ), ŃĐ”ĐœŃŃĐ°Đ»ŃĐœĐŸĐłĐŸ ĐČĐ”ĐœĐŸĐ·ĐœĐŸĐłĐŸ ĐŽĐ°ĐČлД ĐœĐžŃ (ĐŠĐĐ), ŃĐ°ŃŃĐŸŃŃ ŃĐ”ŃĐŽĐ”ŃĐœŃŃ ŃĐŸĐșŃĐ°ŃĐ”ĐœĐžĐč (ЧХХ) Đž ŃĐ”ĐŒĐżĐ° ĐŽĐžŃŃДза. Đ ŃĐČŃĐ·Đž Ń ŃŃĐžĐŒ, ŃДлŃŃ ĐœĐ°ŃĐ”ĐłĐŸ ĐžŃŃĐ»Đ”ĐŽĐŸĐČĐ°ĐœĐžŃ ŃĐČĐž лаŃŃ ĐŸŃĐ”ĐœĐșĐ° ĐČĐŸĐ·ĐŽĐ”ĐčŃŃĐČĐžŃ Đ°Đ»ĐłĐŸŃĐžŃĐŒĐ°, ĐŸŃĐœĐŸĐČĐ°ĐœĐœĐŸĐłĐŸ ĐœĐ° ĐșĐŸĐŒĐżĐ»Đ”ĐșŃĐœĐŸĐŒ ĐŒĐŸĐœĐžŃĐŸŃĐžĐœĐłĐ” ĐłĐ”ĐŒĐŸĐŽĐžĐœĐ°ĐŒĐžĐșĐž Đž ŃŃĐ°ĐœŃĐżĐŸŃŃĐ° ĐșĐžŃĐ»ĐŸŃĐŸĐŽĐ°, ĐœĐ° пДŃĐžĐŸĐżĐ”ŃĐ°ŃĐžĐŸĐœĐœŃŃ ĐžĐœŃŃĐ·ĐžĐŸĐœĐœŃŃ ŃĐ”ŃĐ° ĐżĐžŃ Đž ĐșĐŸŃŃĐ”ĐșŃĐžŃ ĐłĐ”ĐŒĐŸĐŽĐžĐœĐ°ĐŒĐžĐșĐž, Đ° ŃĐ°ĐșжД ĐœĐ° ĐżŃĐŸĐŽĐŸĐ»Đ¶Đž ŃДлŃĐœĐŸŃŃŃ ĐżĐŸŃĐ»Đ”ĐŸĐżĐ”ŃĐ°ŃĐžĐŸĐœĐœĐŸĐłĐŸ ĐżŃДбŃĐČĐ°ĐœĐžŃ ĐČ ĐŸŃЎДлД ĐœĐžĐž ĐžĐœŃĐ”ĐœŃĐžĐČĐœĐŸĐč ŃĐ”ŃапОО (ĐĐĐą) Đž ŃŃĐ°ŃĐžĐŸĐœĐ°ŃĐ” Ń ĐżĐ°ŃĐžĐ”ĐœŃĐŸĐČ Ń ĐĐĐš бДз ĐĐ
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