Goal-directed therapy in cardiac surgery: a systematic review and meta-analysis

Aya, H.; Cecconi, Maurizio; Hamilton, M.; Rhodes, Andrew

doi:10.1093/bja/aet020

Cited by 216 publications

(156 citation statements)

References 35 publications

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“…In accord with the mean duration of hTEE probe insertion [17], our results emphasize the role of cardiac visualization early in the postoperative course in order to detect (new) cardiac dysfunction, i.e. especially RV failure, optimize hemodynamics and improve patients management [11,16]. In this context, it is worth noticing that we observed a non-significant trend towards improved in-hospital mortality in the hTEE group.…”

Section: Discussionsupporting

confidence: 82%

“…Therefore, in cases of unexplained life-threatening hemodynamic instability-possibly persisting despite corrective therapy-a multiplane transesophageal echocardiographic examination is recommended (Class I indication) to identify the underlying pathophysiological cause, e.g. hypovolemia, reduced myocardial contractility, pericardial tamponade [9], and to guide goal-directed therapy [10,11].…”

Section: Introductionmentioning

confidence: 99%

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Feasibility and influence of hTEE monitoring on postoperative management in cardiac surgery patients

Treskatsch

Balzer

Knebel

et al. 2015

Int J Cardiovasc Imaging

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Monoplane hemodynamic TEE (hTEE) monitoring (ImaCor(®) ClariTEE(®)) might be a useful alternative to continuously evaluate cardiovascular function and we aimed to investigate the feasibility and influence of hTEE monitoring on postoperative management in cardiac surgery patients. After IRB approval we reviewed the electronic data of cardiac surgery patients admitted to our intensive care between 01/01/2012 and 30/06/2013 in a case-controlled matched-pairs design. Patients were eligible for the study when they presented a sustained hemodynamic instability postoperatively with the clinical need of an extended hemodynamic monitoring: (a) hTEE (hTEE group, n = 18), or (b) transpulmonary thermodilution (control group, n = 18). hTEE was performed by ICU residents after receiving an approximately 6-h hTEE training session. For hTEE guided hemodynamic optimization an institutional algorithm was used. The hTEE probe was blindly inserted at the first attempt in all patients and image quality was at least judged to be adequate. The frequency of hemodynamic examinations was higher (ten complete hTEE examinations every 2.6 h) in contrast to the control group (one examination every 8 h). hTEE findings, including five unexpected right heart failure and one pericardial tamponade, led to a change of current therapy in 89% of patients. The cumulative dose of epinephrine was significantly reduced (p = 0.034) and levosimendan administration was significantly increased (p = 0.047) in the hTEE group. hTEE was non-inferior to the control group in guiding norepinephrine treatment (p = 0.038). hTEE monitoring performed by ICU residents was feasible and beneficially influenced the postoperative management of cardiac surgery patients.

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Feasibility and influence of hTEE monitoring on postoperative management in cardiac surgery patients

Treskatsch

Balzer

Knebel

et al. 2015

Int J Cardiovasc Imaging

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“…Проте при всіх цих зазначених перевагах не спостерігається зменшення летальності. Аналогічні результати ра-ніш було отримані H. Aya [61,62].…”

Section: рідинне забезпечення у хворих із супутньою патологією серцевunclassified

Проблеми Компенсації Операційної Крововтрати: Стратегії Об’ємної Гемодинамічної Підтримки (Аналітичний Огляд)

Курсов¹,

Biletskyy²,

Lyzogub³

et al. 2022

ЕМ

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Усунення негативних впливів значної інтраопе-раційної крововтрати ще й досі являє серйозну про-блему сучасного анестезіологічного забезпечення та хірургічної техніки. Ще, здавалося б, абсолютно очевидні та прозорі положення рідинної ресусцита-ції в умовах значної крововтрати в останні 8-10 ро-ків інтенсивно переглядаються та знову піддаються ретельному аналізу [1][2][3]. На перший план надання допомоги знову виходить застосування цільної кро-ві та її компонентів [4][5][6]. Особливу увагу приділя-ють вибору режиму заповнення крововтрати (лібе-ральний проти рестриктивного) [7][8][9]. В останніх європейських та американських настановах, що присвячені питанням компенсації періопераційної крововтрати, а також проблемі масивної крововтра-ти, експерти стають на бік прихильників рестрик-тивного режиму інфузійної терапії [10][11][12]. Про-те багато питань викликає застосування тактики малооб'ємної та гіпотензивної рідинної ресусцита-

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“…On the other hand, in cardiac surgical patients only another four RCT focused on GDT were published: two of these studies used PAC [99,100] and two used esophageal Doppler monitoring [101,102] in the study arm. None of these seven GDT-RCT (all were single-centered, less than 1,000 patients studied in all studies between 1995 and 2012) demonstrated their usefulness in decreasing mortality in cardiac surgical patients, but they did reduce morbidity (postoperative complications) and hospital length of stay [5,103,104]. There are some potential causes which could explain the fact that despite the application of modern flow-related GDT protocols the results in cardiac surgery are poor related to mortality and in contrast with the data found in non-cardiac surgery.…”

Section: The Place Of Apw Monitoring Devices In Gdt In Cardiac Surgicmentioning

confidence: 99%

“…The last decade was characterized by a growing interest in innovating, less invasive devices that could be substituted for the PAC. Some of these new techniques were integrated into appropriate protocols that guide the hemodynamic evaluation and the subsequent therapeutic interventions and it was proven that their optimal use can reduce the morbidity, the mortality and can improve the outcome in both surgical [5][6] and non-surgical patients [7]. These recent technologies DOI: http://dx.doi.org/10.21454/rjaic.7518.231.wvf…”

Section: Introductionmentioning

confidence: 99%

Pulse waveform hemodynamic monitoring devices: recent advances and the place in goal-directed therapy in cardiac surgical patients

Hendy

Bubenek

2016

Rom J Anaesth Int Care

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Hemodynamic monitoring has evolved and improved greatly during the past decades as the medical approach has shifted from a static to a functional approach. The technological advances have led to innovating calibrated or not, but minimally invasive and noninvasive devices based on arterial pressure waveform (APW) analysis. This systematic clinical review outlines the physiologic rationale behind these recent technologies. We describe the strengths and the limitations of each method in terms of accuracy and precision of measuring the flow parameters (stroke volume, cardiac output) and dynamic parameters which predict the fluid responsiveness. We also analyzed the place of the APW monitoring devices in goaldirected therapy (GDT) protocols in cardiac surgical patients. According to the data from the three GDTrandomized control trials performed in cardiac surgery (using two types of APW techniques PiCCO and FloTrac/Vigileo), these devices did not demonstrate that they played a role in decreasing mortality, but only decreasing the ventilation time and the ICU and hospital length of stay.

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Goal-directed therapy in cardiac surgery: a systematic review and meta-analysis

Abstract: The use of pre-emptive GDT in cardiac surgery reduces morbidity and hospital length of stay.

Cited by 216 publications

References 35 publications

Feasibility and influence of hTEE monitoring on postoperative management in cardiac surgery patients

Feasibility and influence of hTEE monitoring on postoperative management in cardiac surgery patients

Проблеми Компенсації Операційної Крововтрати: Стратегії Об’ємної Гемодинамічної Підтримки (Аналітичний Огляд)

Pulse waveform hemodynamic monitoring devices: recent advances and the place in goal-directed therapy in cardiac surgical patients

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