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Efficacy of Goal-Directed Therapy Using Bioreactance Cardiac Output Monitoring after Valvular Heart Surgery.
Yonsei Med J. 2015 Jul; 56(4):913-20.YM

Abstract

PURPOSE

We compared the efficacy of postoperative hemodynamic goal-directed therapy (GDT) using a pulmonary artery catheter (PAC) and bioreactance-based noninvasive cardiac output monitoring (NICOM) in patients with atrial fibrillation undergoing valvular heart surgery.

MATERIALS AND METHODS

Fifty eight patients were randomized into two groups of GDT with common goals to maintain a mean arterial pressure of 60-80 mm Hg and cardiac index ≥2 L/min/m²: the PAC group (n=29), based on pulmonary capillary wedge pressure, and the NICOM group (n=29), based on changes in stroke volume index after passive leg raising. The primary efficacy variable was length of hospital stay. Secondary efficacy variables included resource utilization including vasopressor and inotropic requirement, fluid balance, and major morbidity endpoints.

RESULTS

Patient characteristics and operative data were similar between the groups, except that significantly more patients underwent double valve replacement in the NICOM group. The lengths of hospital stay were not different between the two groups (12.2±4.8 days vs. 10.8±4.0 days, p=0.239). Numbers of patients requiring epinephrine (5 vs. 0, p=0.019) and ventilator care >24 h (6 vs. 1, p=0.044) were significantly higher in the PAC group. The PAC group also required significantly larger amounts of colloid (1652±519 mL vs. 11430±463 mL, p=0.004).

CONCLUSION

NICOM-based postoperative hemodynamic GDT showed promising results in patients with atrial fibrillation undergoing valvular heart surgery in terms of resource utilization.

Authors+Show Affiliations

Department of Thoracic and Cardiovascular Surgery, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.Department of Thoracic and Cardiovascular Surgery, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.Department of Thoracic and Cardiovascular Surgery, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea. aneshim@yuhs.ac.

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26069111

Citation

Lee, Sak, et al. "Efficacy of Goal-Directed Therapy Using Bioreactance Cardiac Output Monitoring After Valvular Heart Surgery." Yonsei Medical Journal, vol. 56, no. 4, 2015, pp. 913-20.
Lee S, Lee SH, Chang BC, et al. Efficacy of Goal-Directed Therapy Using Bioreactance Cardiac Output Monitoring after Valvular Heart Surgery. Yonsei Med J. 2015;56(4):913-20.
Lee, S., Lee, S. H., Chang, B. C., & Shim, J. K. (2015). Efficacy of Goal-Directed Therapy Using Bioreactance Cardiac Output Monitoring after Valvular Heart Surgery. Yonsei Medical Journal, 56(4), 913-20. https://doi.org/10.3349/ymj.2015.56.4.913
Lee S, et al. Efficacy of Goal-Directed Therapy Using Bioreactance Cardiac Output Monitoring After Valvular Heart Surgery. Yonsei Med J. 2015;56(4):913-20. PubMed PMID: 26069111.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy of Goal-Directed Therapy Using Bioreactance Cardiac Output Monitoring after Valvular Heart Surgery. AU - Lee,Sak, AU - Lee,Seung Hyun, AU - Chang,Byung-Chul, AU - Shim,Jae-Kwang, PY - 2015/6/13/entrez PY - 2015/6/13/pubmed PY - 2015/12/15/medline KW - Pulmonary artery catheterization KW - atrial fibrillation KW - goal directed therapy KW - non-invasive cardiac output monitoring KW - valvular heart surgery SP - 913 EP - 20 JF - Yonsei medical journal JO - Yonsei Med. J. VL - 56 IS - 4 N2 - PURPOSE: We compared the efficacy of postoperative hemodynamic goal-directed therapy (GDT) using a pulmonary artery catheter (PAC) and bioreactance-based noninvasive cardiac output monitoring (NICOM) in patients with atrial fibrillation undergoing valvular heart surgery. MATERIALS AND METHODS: Fifty eight patients were randomized into two groups of GDT with common goals to maintain a mean arterial pressure of 60-80 mm Hg and cardiac index ≥2 L/min/m²: the PAC group (n=29), based on pulmonary capillary wedge pressure, and the NICOM group (n=29), based on changes in stroke volume index after passive leg raising. The primary efficacy variable was length of hospital stay. Secondary efficacy variables included resource utilization including vasopressor and inotropic requirement, fluid balance, and major morbidity endpoints. RESULTS: Patient characteristics and operative data were similar between the groups, except that significantly more patients underwent double valve replacement in the NICOM group. The lengths of hospital stay were not different between the two groups (12.2±4.8 days vs. 10.8±4.0 days, p=0.239). Numbers of patients requiring epinephrine (5 vs. 0, p=0.019) and ventilator care >24 h (6 vs. 1, p=0.044) were significantly higher in the PAC group. The PAC group also required significantly larger amounts of colloid (1652±519 mL vs. 11430±463 mL, p=0.004). CONCLUSION: NICOM-based postoperative hemodynamic GDT showed promising results in patients with atrial fibrillation undergoing valvular heart surgery in terms of resource utilization. SN - 1976-2437 UR - https://www.unboundmedicine.com/medline/citation/26069111/Efficacy_of_Goal_Directed_Therapy_Using_Bioreactance_Cardiac_Output_Monitoring_after_Valvular_Heart_Surgery_ L2 - https://www.eymj.org/DOIx.php?id=10.3349/ymj.2015.56.4.913 DB - PRIME DP - Unbound Medicine ER -