Abstract
BackgroundStudies suggest that Goal Directed Therapy (GDT) results in improved outcome following major surgery. However, there is concern that pre-emptive use of inotropic therapy may lead to an increased incidence of myocardial ischaemia and infarction.MethodsPost hoc analysis of data collected prospectively during a randomised controlled trial of the effects of post-operative GDT in high-risk general surgical patients. Serum troponin T concentrations were measured at baseline and on day 1 and day 2 following surgery. Continuous ECG monitoring was performed during the eight hour intervention period. Patients were followed up for predefined cardiac complications. A univariate analysis was performed to identify any associations between potential risk factors for myocardial injury and elevated troponin T concentrations.ResultsGDT was associated with fewer complications, and a reduced duration of hospital stay. Troponin T concentrations above 0.01 μg l-1 were identified in eight patients in the GDT group and six in the control group. Values increased above 0.05 μg l-1 in four patients in the GDT group and two patients in the control group. There were no overall differences in the incidence of elevated troponin T concentrations. The incidence of cardiovascular complications was also similar. None of the patients, in whom troponin T concentrations were elevated, developed ECG changes indicating myocardial ischaemia during the intervention period. The only factor to be associated with elevated troponin T concentrations following surgery was end-stage renal failure.ConclusionThe use of post-operative GDT does not result in an increased incidence of myocardial injury.
Highlights
Studies suggest that Goal Directed Therapy (GDT) results in improved outcome following major surgery
The use of post-operative GDT does not result in an increased incidence of myocardial injury
The use of post-operative GDT does not appear to result in an increased incidence of myocardial injury detected through clinical, electrocardiographic or biochemical means
Summary
Studies suggest that Goal Directed Therapy (GDT) results in improved outcome following major surgery. There is concern that pre-emptive use of inotropic therapy may lead to an increased incidence of myocardial ischaemia and infarction. The term Goal Directed Therapy (GDT) describes the use of intra-venous fluid and inotropic agents to increase cardiac output and related haemodynamic parameters to predetermined levels. There has been some concern that the pre-emptive use of inotropic therapy in the absence of traditional indications for such treatment, may lead to an increased incidence of myocardial ischaemia and infarction. The incidence of ischaemic heart disease in patients undergoing major surgery is high [7], and it is possible that the use of pharmacological agents which increase myocardial work at a time of increased physiological stress may result in an imbalance of myocardial oxygen supply and demand. The absence of data describing the myocardial effects of GDT is an important obstacle to the wider use of this potentially beneficial treatment
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