Use of noradrenaline (NA) in the early postoperative (PO) period of myocardial revascularization (MR) surgery in a group of patients with a short stay in the intensive care unit

Background

NA has been used in surgical intensive care units (ICUs) in the PO period of MR, aiming at decreasing the need for excessive blood volume restoration and its possible complications.

Objective

To assess the impact on hospital costs of the use of NA initiated in the first 12 hours in patients with a short length of stay in the ICU in the PO period of MR, and to compare other variables between the groups using or not using that drug.

Patients and methods

The use of NA initiated in the first 12 hours and the costs of hospitalization were studied in 268 adult patients undergoing MR and discharged from the ICU within the first 48 PO hours (94 patients received NA and 174 patients did not receive the drug). Other variables, such as fluid balance in the operation room and fluid balance in the first 24 hours (FBD1) of the PO period, extracorporeal circulation time (ECCt), mortality prediction score of the American Heart Association (mAHA), serum level of lactate in the postoperative period (first day), and postoperative multiple organ dysfunction syndrome and Sepsis-related Organ Failure Assessment (SOFA) scores, were also analyzed. The following statistical tests were used: Student t test, Wilcoxon text, rank sum text, and linear regression text.

Results

The use of NA was not an independent predictor of hospital costs in this group of patients. The ECCt and the preoperative mAHA score were cost predictors, but influenced only 9.2% of the variation. The comparisons between the groups of the mAHA score, the ECCt, the fluid balance in the operation room, and the serum level of lactate in the early PO period did not show any statistically significant difference. The group receiving NA had a significantly greater FBD1 (0.9 × 0.2 ml/kg per hour) with P < 0.00001. The MODS and SOFA scores were also significantly greater with P = 0.01 and P < 0.00001, respectively.

Conclusion

The early use of NA in the PO period of MR was not an independent predictor of cost in this group of patients who stayed in the ICU less than 48 hours. The preoperative variables were similar in the groups. The postoperative MODS and SOFA scores were greater in the group receiving the drug, but their values were impaired because the use of the drug was one of their components. The FBD1 was significantly greater in the group receiving the drug, which may be a marker of a different outcome, justifying further studies.