Early goal-directed therapy based on endotracheal bioimpedance cardiography: a prospective, randomized controlled study in coronary surgery

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• 作者：Jean-Luc Fellahi ; David Brossier…
• 关键词：Mini ; invasive cardiac output monitoring ; Endotracheal Cardiac Output Monitor ; Goal ; directed hemodynamic therapy ; Coronary surgery
• 刊名：Journal of Clinical Monitoring and Computing
• 出版年：2015
• 出版时间：June 2015
• 年：2015
• 卷：29
• 期：3
• 页码：351-358
• 全文大小：488 KB
• 参考文献：1.Ferguson TB Jr, Hammill BG, Peterson ED, DeLong ER, Grover FL. STS National Database Committee: a decade of change-risk profiles and outcomes for isolated coronary artery bypass grafting procedures, 1990-999: a report from the STS National Database Committee and the Duke Clinical Research Institute. Society of Thoracic Surgeons. Ann Thorac Surg. 2002;73:480- discussion 9-0.View Article PubMed
  2.Scott BH, Seifert FC, Grimson R, Glass PS. Octogenarians undergoing coronary artery bypass graft surgery: resource utilization, postoperative mortality, and morbidity. J Cardiothorac Vasc Anesth. 2005;19:583-.View Article PubMed
  3.Phan TD, Ismail H, Herior AG, Ho KM. Improving perioperative outcomes: fluid optimization with the esophageal Doppler monitor, a meta-analysis and review. J Am Coll Surg. 2008;207:935-1.View Article PubMed
  4.Hamilton M, Cecconi M, Rhodes A. A systematic review and meta-analysis on the use of preemptive hemodynamic intervention to improve postoperative outcomes in moderate and high-risk surgical patients. Anesth Analg. 2011;112:1392-02.View Article PubMed
  5.Aya HD, Cecconi M, Hamilton M, Rhodes A. Goal-directed therapy in cardiac surgery: a systematic review and meta-analysis. Br J Anaesth. 2013;110:510-.View Article PubMed
  6.Cannesson M, Pestel G, Ricks C, Hoeft A, Perel A. Hemodynamic monitoring and management in patients undergoing high risk surgery: a survey among North American and European anesthesiologists. Crit Care. 2011;15:R197.View Article PubMed Central PubMed
  7.Marik PE. Noninvasive cardiac output monitors: a state-of the-art review. J Cardiothorac Vasc Anesth. 2013;27:121-4.View Article PubMed
  8.Wallace AW, Salahieh A, Lawrence A, Spector K, Owens C, Alonso D. Endotracheal cardiac output monitor. Anesthesiology. 2000;92:178-9.View Article PubMed
  9.Ball TR, Culp BC, Patel V, Gloyna DF, Ciceri DP, Culp WC Jr. Comparison of the endotracheal cardiac output monitor to thermodilution in cardiac surgery patients. J Cardiothorac Vasc Anesth. 2010;24:762-.View Article PubMed
  10.Maus TM, Reber B, Banks DA, Berry A, Guerrero E, Manecke GR. Cardiac output determination from endotracheally measured impedance cardiography: clinical evaluation of endotracheal cardiac output monitor. J Cardiothorac Vasc Anesth. 2011;25:770-.View Article PubMed
  11.Fellahi JL, Fischer MO, Rebet O, Massetti M, Gerard JL, Hanouz JL. A comparison of endotracheal bioimpedance cardiography and transpulmonary thermodilution in cardiac surgery patients. J Cardiothorac Vasc Anesth. 2012;26:217-2.View Article PubMed
  12.Moller-Sorenson H, Hansen KL, Ostergaard M, Andersen LW, Moller K. Lack of agreement and trending ability of the endotracheal cardiac output monitor compared with thermodilution. Acta Anaesthesiol Scand. 2012;56:433-0.View Article
  13.Fellahi JL, Fischer MO, Dalbera A, Massetti M, Gerard JL, Hanouz JL. Can endotracheal bioimpedance cardiography assess hemodynamic response to passive leg raising following cardiac surgery? Ann Intensive Care. 2012;2:26.View Article PubMed Central PubMed
  14.Van der Kleij SCJ, Koolen BB, Newhall DA, et al. Clinical evaluation of a new tracheal impedance cardiography method. Anaesthesia. 2012;67:729-3.View Article PubMed
  15.Moher D, Schulz KF, Altman DG. The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. Lancet. 2001;357:1191-.View Article PubMed
  16.Goepfert MS, Richter HP, Eulenburg CZ, et al. Individually optimized hemodynamic therapy reduces complications and length of stay in the intensive care unit: a prospective, randomized controlled study. Anesthesiology. 2013;119:824-6.View Article PubMed
  17.Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD, Joint ESC/ACCF/AHA/WHF Task Force for the Universal Definition of Myocardial Infarction, Katus HA, Lindahl B, Morrow DA, Clemmensen PM, Johanson P, Hod H, Underwood R, Bax JJ, Bonow RO, Pinto F, Gibbons RJ, Fox KA, Atar D, Newby LK, Galvani M, Hamm CW, Uretsky BF, Steg PG, Wijns W, Bassand JP, Menasché P, Ravkilde J, Ohman EM, Antman EM, Wallentin LC, Armstrong PW, Simoons ML, Januzzi JL, Nieminen MS, Gheorghiade M, Filippatos G, Luepker RV, Fortmann SP, Rosamond WD, Levy D, Wood D, Smith SC, Hu D, Lopez-Sendon JL, Robertson RM, Weaver D, Tendera M, Bove AA, Parkhomenko AN, Vasilieva EJ, Mendis S. Third universal definition of myocardial infarction. Circulation. 2012;126:2020-5.View Article PubMed
  18.Fellahi JL, Hédoire F, Le Manach Y, Monier E, Guillou L, Riou B. Determination of the threshold of cardiac troponin I associated with an adverse postoperative outcome after cardiac surgery: a comparative study between coronary artery bypass graft, valve surgery, and combined cardiac surgery. Crit Care. 2007;11:R106.View Article PubMed Central PubMed
  19.Polonen P, Ruokonen E, Hippelainen M, Poyhonen M, Takala J. A prospective, randomized study of goal-oriented he
• 作者单位：Jean-Luc Fellahi (1)
  David Brossier (2)
  Fabien Dechanet (2)
  Marc-Olivier Fischer (2)
  Vladimir Saplacan (3)
  Jean-Louis Gérard (2)
  Jean-Luc Hanouz (2)
  
  1. Department of Anesthesiology and Critical Care Medicine, H?pital Cardiovasculaire et Pneumologique Louis Pradel, Hospices Civils de Lyon, 28 avenue du Doyen Lépine, 69677, Lyon-Bron Cedex, France
  2. Department of Anesthesiology and Critical Care Medicine, CHU de Caen, Avenue de la C?te de Nacre, 14000, Caen, France
  3. Department of Cardiothoracic Surgery, CHU de Caen, Avenue de la C?te de Nacre, 14000, Caen, France
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Anesthesiology
  Intensive and Critical Care Medicine
  Statistics for Life Sciences, Medicine and Health Sciences
  
• 出版者：Springer Netherlands
• ISSN：1573-2614

文摘

The objective was to compare the impact of an early goal-directed hemodynamic therapy based on cardiac output monitoring (Endotracheal Cardiac Output Monitor, ECOM) with a standard of care on postoperative outcome following coronary surgery. This prospective, controlled, parallel-arm trial randomized 100 elective primary coronary artery bypass grafting patients to a study group (ECOM; n?=?50) or a control group (control; n?=?50). In the ECOM group, hemodynamic therapy was guided by respiratory stroke volume variation and cardiac index given by the ECOM system. A standard of care was used in the control. Goal-directed therapy was started immediately after induction of anesthesia and continued until arrival in the intensive care unit (ICU). The primary endpoint was the time when patients fulfilled discharge criteria from hospital (possible hospital discharge). Secondary endpoints were the hospital discharge, the time to reach extubation, the length of stay in ICU, the number of major adverse cardiac events, and in-hospital mortality. Patients in the ECOM group received more often fluid loading and dobutamine. The time to reach extubation was reduced in the ECOM group: 510?min [360-,110] versus 570?min [320-,520], P?=?0.005. No significant differences were found between both groups for possible hospital discharge [Hazard Ratio?=?0.96 (95?%?CI?0.64-.45)] and hospital discharge [Hazard Ratio?=?1.20 (95?% CI?0.79-.81)]. A mini-invasive early goal-directed hemodynamic therapy based on ECOM can reduce the time to reach extubation but fails to significantly reduce the length of stay in hospital and the rate of major cardiac morbidity.