Yonsei Med J.  2015 Jul;56(4):913-920. 10.3349/ymj.2015.56.4.913.

Efficacy of Goal-Directed Therapy Using Bioreactance Cardiac Output Monitoring after Valvular Heart Surgery

• Lee S
• Lee SH
• Chang BC
• Shim JK

• KMID: 2366329
• DOI: http://doi.org/10.3349/ymj.2015.56.4.913

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 > or =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.

Keyword

Pulmonary artery catheterization; goal directed therapy; non-invasive cardiac output monitoring; atrial fibrillation; valvular heart surgery

MeSH Terms

Aged
Aged, 80 and over
Cardiac Output/*physiology
Cardiac Surgical Procedures/*methods
Catheterization, Swan-Ganz
Female
Goals
Heart Valves/*surgery
Hemodynamics
Humans
Length of Stay/*statistics & numerical data
Male
Middle Aged
Monitoring, Intraoperative/methods
Monitoring, Physiologic/methods
Postoperative Complications/epidemiology/prevention & control
Postoperative Period

Figure

• 

  Fig. 1 Goal directed therapy algorithm based on pulmonary artery catheters. PCWP, pulmonary capillary wedge pressure; RBC, red blood cell; BP, blood pressure; CI, cardiac index; Hb, hemoglobin.

• 

  Fig. 2 Goal directed therapy algorithm based on Noninvasive Cardiac Output Monitoring system. PLR, passive leg raise; SVI, stroke volume index; RBC, red blood cell; Hb, hemoglobin; BP, blood pressure; CI, cardiac index.

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