Optimized Hemodynamic Therapy
in Cardiac Surgery Patients
Complications
reduced by
Length of ICU stay
reduced by
36%
Control Group
Study Group
32%
Control Group
Study Group
Early goal-directed therapy reduces intensive care
stay after cardiac surgery
Extravascular Lung Water Index (ELWI) can serve as a warning
parameter for volume overload
Fluid Management: timing is everything!
Individualise your treatment
Individually Optimized Hemodynamic Therapy Reduces
Complications and Length of Stay in the Intensive Care Unit
A Prospective, Randomised Controlled Trial
Goepfert MS, Richter HP, Eulenburg CZ, Gruetzmacher J, Rafflenbeul E, Roeher K,
Sandersleben AV, Diedrichs S, Reichenspurner H, Goetz AE, Reuter DA
Hamburg-Eppendorf, Germany
Anesthesiology 2013; epub
Prospective Randomised Controlled Trial
Goal-directed hemodynamic therapy, based on the combination of functional and volumetric hemodynamic
parameters, improves outcome in patients with cardiac surgery.
Coronary Artery Bypass Grafting (CABG), Aortic Valve Replacement (AVR), CABG + AVR
PiCCO Monitor with PiCCO femoral artery catheter
Authors
Center
Journal
Study Type
Hypothesis
Surgeries
Technology
No of patients
GDT parameters
Study Group (SG)
50
SVV, GEDI, ELWI, CI, MAP
GDT
SVV
GEDI
ELWI
CI
MAP
CVP
HR
Control Group (CG)
50
MAP, CVP, HR
Study Group
SVV 10%
YES
NO
Optimal GEDI
reached or
SVV 10%
Define
optimal GEDI
YES
CI > 2.0
[l/min/m-2]
ELWI > 12 ml/kg
or CI decreasing
Consider
diuretics
Pacing
Orciprenaline
Atropine
Analgesia
Sedation
-Blockers
RBC Transfusion
NO
Pacing 90/min
Orciprenaline
Atropine
HR 50-100
[bpm]
NO
Vasopressor
YES
STOP
ELWI > 12 ml/kg
or CI decreasing
YES
NO
HR < 50
[bpm]
Give volume until
opt GEDI is reached
or SVV 10%
(observe CI and ELWI)
STOP
MAP > 65
[mmHg]
NO
NO
Give volume until
SVV 10%
(observe CI and ELWI)
YES
Goal Directed Therapy
Stroke Volume Variation
Global End-Diastolic Volume Index
Extravascular Lung Water Index
Cardiac Index
Mean Arterial Pressure
Central Venous Pressure
Heart Rate
Catecholamines
Consider
diuretics
Algorithm 1: SVV was used to optimize preload. After volume optimization, GEDI was measured and noted as optGEDI.
Algorithm 2: The individually titrated optGEDI served as the goal for preload optimization in clinical situations where SVV was not feasible.
Control Group
NO
NO
CVP > 8
[mmHg]
NO
Give volume until
MAP > 65 [mmHg] or
CVP > 8 [mmHg]
YES
HR > 50
[bpm]
YES
Pacing
Orciprenaline
Atropine
Vasopressors
Catecholamines
HR < 110
[bpm]
YES
OK
NO
Sedation
Analgesia
RBC Transfusion
-Blockade
Antiarrhytmics
Algorithm 3: Hemodynamic algorithm for patients in the control group
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PULSION 11/2013 MPI4105US_R00
YES
MAP > 65
[mmHg]
