Objective: to study the impact of goal oriented infusion therapy using balanced salt solution, 4% succinylated gelatin, and 6% hydroxyethyl starch 130/0.42 solution on pulmonary extravascular water levels in coronary heart disease patients oper ated on under extracorporeal circulation. Materials and methods. A prospective, randomized, single blind clinical study investigating the impact of goal oriented infusion therapy using balanced salt solution, 4% succinylated gelatin, and 6% hydroxyethyl starch 130/0.42 solution on pulmonary extravascular water levels was conducted in coronary heart disease patents operated on under extracorporeal circulation. The hemodynamic target was the global end diastolic volume index which was maintained in the range from 680 to 850 ml/m 2 . Pulmonary extravascular water was measured by a transpul monary thermodilution technique; hydrobalance, lactate, mixed venous oxygen saturation, hemodynamic parameters, and troponin I concentrations were also investigated. Results. Analysis of the values of the pulmonary extravascular water index revealed no differences between the groups in pulmonary extravascular water levels throughout the study. Large vol umes of balanced crystalloid solution were required to maintain intraoperative and postoperative hemodynamics. Balance

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Introduction: Routinely monitored parameters such as blood pressure (BP) and heart rate may not reliably detect per- fusion abnormalities. However, central venous oxygen saturation (ScvO₂) and lactate levels can detect occult hypoper- fusion (OH) and identify patients at risk for complications. The study objective was to assess the impact of an OH treatment pathway on morbidity and length of stay (LOS) post coronary bypass and valve surgery. Methods: This is a prospective cohort observational study following the implementation of a treatment pathway for OH, defined by ScvO₂ < 70% and lactate ≥ 2 mMol/L with systolic BP ≥ 90 mmHg. Initial treatment included volume resuscitation and/or blood transfusion, followed by additional interventions when ScvO₂ remained < 70%. Repeat lactate was obtained 18 hours postoperatively. Primary outcomes were intensive care unit (ICU)/hospital LOS and complications. Results: Comparing 53 patients managed by the OH pathway against 21 historical controls, median ICU LOS was 40.4 vs. 49.2 hours (p = 0.122), median hospital LOS 9.2 vs. 11.0 days (p = 0.0093), ICU readmission rate 7.5% vs. 28.6% (p = 0.026), and complication rate 26.4% vs. 47.6% (p = 0.101). Repeat lactate was checked 18 hours postoperatively in 47 of the 53 patients. Comparing 33 patients with repeat lactate at goal (< 2 mMoL/L) with 14 patients not at goal, median ICU LOS was 35.3 vs. 68.4 hours (p = 0.061), median hospital LOS 8.9 vs. 11.2 days (p = 0.058), median length of mechanical ventilation (LOMV) 13.3 vs. 28.4 hours (p = 0.0038), and complication rate 15.2% vs. 50.0% (p = 0.025). Conclusions: An OH screening and treatment pathway following cardiovascular surgery was associated with signifi- cantly shorter hospital LOS and lower ICU readmission rate. Among the OH pathway patients, achieving lactate goal 18 hours postoperatively was associated with significantly shorter LOMV and lower complication rate.

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