A prospective randomized study of goal oriented hemodynamic therapy in cardiac surgical patients

Abstract

Introduction: Approximately 10% of patients require prolonged care after cardiac surgery because of hemodynamic instability, organ dysfunction or multi organ failure. Increased levels of oxygen delivery and consumption in early postoperative period are associated with improved outcome and early recovery. The aim of the study was to evaluate early post- operative outcome in cardiac surgery patients with adoption of goal oriented hemodynamic therapy.

Methods: This is a prospective randomized controlled trial of 12 months period, of adult patients undergoing cardiac surgery in a tertiary level teaching hospital. In the control group, standard postoperative monitoring was done, while in the study group FloTrac TM cardiac output sensor with Vigileo monitor and central venous oxygen saturation monitoring was done to reach a set goal within 8 hrs postoperatively. Findings were analysed using SPSS software version 17.

Results: 100 patients were enrolled in the study with 50 in each group. Both groups were comparable by baseline characteristics, body surface area (BSA) and duration of surgery, cardiopulmonary bypass (CPB) and aortic cross-clamp (AoX) time. But the average age was statistically higher in study group. Yet, the ventilator time and duration of use of ionotropes were significantly less in study group. The duration of intensive care unit (ICU) and hospital stay were less in study group but did not reach statistical significance.

Conclusion: This study has shown that the use of goal oriented hemodynamic therapy in cardiac surgical patients improves immediate outcome. Mortality, ICU and hospital stay also tend to be lower.