- Poster presentation
- Open access
- Published:
Goal-directed hemodynamic resuscitation in high-risk patients undergoing cardiac surgery: a randomized controlled trial - preliminary data (GRICCS STUDY)
Critical Care volume 16, Article number: P197 (2012)
Introduction
Low cardiac output is a frequent clinical circumstance after cardiac surgery and results in higher morbidity and mortality rates. Goal-directed therapy (GDT) is a validated design that has been proved to reduce the number of perioperative outcomes. We investigated the results of a cardiac index optimization protocol through the use of the LiDCO rapid device.
Methods
A prospective study that randomized 34 high-risk patients (EuroSCORE higher than 6 or LVEF lower than 45%) to a GDT protocol or a conventional hemodynamic therapy. Patients from the GDT group were resuscitated to a cardiac index higher than 3 l/minute/m2 through the implementation of a three-step approach: (1) fluid challenge of 250 ml aliquots, (2) dobutamine infusion up to a dose of 20 μg/kg/minute, and (3) blood transfusion to reach a hematocrit higher than 28%. The control group was managed according to institutional protocol. Categorical variables were compared using Fisher's exact test and categorical variables were compared using the Mann-Whitney U test.
Results
Sixteen patients from the GDT group were compared with 18 patients from the control group. There was a tendency towards reduction in ICU stay in patients from GDT group in relation to the control group (7 days vs. 6 days, P = 0.18). Comparison of the primary endpoint variable (composite of death or major postoperative complications within 30 days after surgery or before discharge) between groups showed a reduced complication rate in the GDT group (52.2% vs. 45.6%, P = 0.12), mainly attributed to worse acute renal failure RIFLE criteria in the control group.
Conclusion
Goal-directed hemodynamic resuscitation with the use of a minimally invasive device seems to be a promising perioperative strategy aimed at reducing the rates of worse outcomes and the ICU stay after cardiac surgery.
Author information
Authors and Affiliations
Rights and permissions
This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
About this article
Cite this article
Osawa, E., Rhodes, A., Fukushima, J. et al. Goal-directed hemodynamic resuscitation in high-risk patients undergoing cardiac surgery: a randomized controlled trial - preliminary data (GRICCS STUDY). Crit Care 16 (Suppl 1), P197 (2012). https://doi.org/10.1186/cc10804
Published:
DOI: https://doi.org/10.1186/cc10804