Abstract
Introduction: Studies have shown that a hemodynamic-guided therapy improves the post operative outcomes of high-risk patients.This study, evaluated if a short period through minimally invasive hemodynamic monitoring, pressure recording analytical method (PRAM), on admission to a post-cardiac surgery step-down unit (SDU), may identify patients at higher risk of 6-month adverse events after cardiac surgery. Methods: From December 2016-May 2017,173 patients were admitted in SDU within 24-48 hours of major cardiac surgery procedure, and submitted to clinical, laboratoristic and echocardiographic evaluation and a 1-hour PRAM recording to obtain a "biohumoral snapshot" of individual patient’s.156 173 patients (17 patients were lost at follow-up) were phone interviewed six months after surgery,to evaluate, as a composite end-point, the adverse events during follow-up. A multivariable logistic regression analysis was used to identify a model clinical-biohumoral (CBM) and clinical-biohumoral hemodynamics (CBHM). Results: No data from past clinical history and no conventional risk score (EuroScore II, STS score)independently predicted the risk of 6-month major events in our study. The risk of adverse events at six-month follow-up was directly related, in the CBM, to sustained post-operative cardiac arrhythmias, higher values of NT-proBNP and of arterial pH; inversely related to values of hs-C-reactive protein (hs-CRP) and, in the CBHM, to low values of cardiac cycle efficiency (CCE) and dP/dtmax. Conclusion: Our study although limited by its observational nature and by the limited number of patients enrolled, showed that a short period of minimally invasive hemodynamic monitoring increased the accuracy to identify patients at major risk of mid-term events after cardiac surgery.
Highlights
Studies have shown that a hemodynamic-guided therapy improves the postoperative outcomes of high-risk patients
No difference was found for any clinical, laboratory or instrumental variable between patients successfully traced and those lost to follow-up
In previous studies, elevated pre-operative NT-proBNP was found a potent predictor of negative events from 136 to 5 years[37] after cardiac surgery: we found that a predictive effect is already evident at 6 months, thereby confirming the usefulness of assaying this parameter in the early post-operative days
Summary
Studies have shown that a hemodynamic-guided therapy improves the postoperative outcomes of high-risk patients. This study, evaluated if a short period through minimally invasive hemodynamic monitoring, pressure recording analytical method (PRAM), on admission to a post-cardiac surgery step-down unit (SDU), may identify patients at higher risk of 6-month adverse events after cardiac surgery. Few tools are available for assessing the clinical stability and, the appropriate patients’ stepping-down during the early course after surgery, especially in high-volume, high-turnover centers, while studies have shown that a hemodynamic-guided therapy improves the postoperative outcomes of high-risk patients.[6,7,8,9,10,11] Pulmonary artery catheterization has been used for this purpose in the past, but the invasiveness of the method with its potentially serious complications,[12] progressively has reduced its routine use. The pressure recording analytical method (PRAM) provides a reliable measure of cardiac output (CO), and of several derived parameters, only by means of a mathematical analysis of the pressure waveform recorded from a radial artery cannula.[13,14] PRAM is a system that simultaneously analyses the systolic and diastolic phase and their interaction.[13]
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