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Intraoperative optimization of hemodynamic parameters is associated with a better outcome after cardiac surgery
Critical Care volume 12, Article number: P260 (2008)
Goal-directed therapy has been used for critically ill patients. The purpose of this study was to evaluate the ability of intraoperative perfusion parameters in predicting outcome after cardiac surgery.
A total of 98 patients undergoing cardiac surgery were prospectively evaluated. Samples of lactate, arterial gases, and central venous saturation (SVO2) were collected 60 minutes after beginning surgery, 120 minutes after and at the end of the procedure. Univariate and multivariate analyses were performed.
Factors associated with cardiac dysfunction were previous low ejection fraction (P = 0.035), surgery with pump (P = 0.001), longer duration of pump (P = 0.003), low initial intra-operative central venous saturation (P = 0.001) and high level of initial gapCO2 (P = 0.02). A low intraoperative SVO2 was independently associated with a sevenfold increase (95% CI, 2–21) and a initial high level of CO2gap with a 4.5-fold increase (95% CI, 1.6–12) in cardiac dysfunction after cardiac surgery. Associated factors with renal dysfunction were age (P = 0.045), longer duration of pump (P = 0.01) and low initial intraoperative central venous saturation (P = 0.001). A low intraoperative SVO2 was associated with a 12-fold increase and a low level of initial base excess with a 27-fold increase in rates of infection after cardiac surgery. A high level of final arterial lactate predicted a longer time of mechanical ventilation (OR, 4.56; 95% CI, 1.4–11.2). There were no relations of perfusion parameters with longer time of stay in the ICU or mortality.
In this observational study, a low intraoperative level of SVO2 is an independent predictor of cardiac dysfunction, renal failure and infection after cardiac surgery and a high level of lactate is associated with a longer time of mechanical ventilation. These findings suggest that these parameters may be markers of prognosis after cardiac surgery.
Rivers E, Nguyen B, et al.: Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001, 345: 1368-1377. 10.1056/NEJMoa010307
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Hajjar, L., Melo, R., Galas, F. et al. Intraoperative optimization of hemodynamic parameters is associated with a better outcome after cardiac surgery. Crit Care 12, P260 (2008). https://doi.org/10.1186/cc6481
- Mechanical Ventilation
- Cardiac Dysfunction
- Hemodynamic Parameter
- Associate Factor