Background. Based on a pilot study with 34 patients, applying the modified sequential organ failure assessment (SOFA) score intraoperatively could predict a prolonged ICU stay, albeit with only 4 risk factors. Our objective was to develop a practicable intraoperative model for predicting prolonged ICU stay which included more relevant risk factors. Methods. An extensive literature review identified 6 other intraoperative risk factors affecting prolonged ICU stay. Another 168 patients were then recruited for whom all 10 risk factors were extracted and analyzed by logistic regression to form the new prognostic model. Results. The multivariate logistic regression analysis retained only 6 significant risk factors in the model: age ≥ 60 years, PaO2/FiO2 ratio ≤ 200 mmHg, platelet count ≤ 120,000/mm3, requirement for inotrope/vasopressor ≥ 2 drugs, serum potassium ≤ 3.2 mEq/L, and atrial fibrillation grading ≥2. This model was then simplified into the Open-Heart Intraoperative Risk (OHIR) score, comprising the same 6 risk factors for a total score of 7—a score of ≥3 indicating a likely prolonged ICU stay (AUC for ROC of 0.746). Conclusions. We developed a new, easy to calculate OHIR scoring system for predicting prolonged ICU stay as early as 3 hours after CPB. It comprises 6 risk factors, 5 of which can be manipulated intraoperatively.

Purpose Early goal-directed therapy (EGDT) using the FloTrac system reportedly improved postoperative outcomes among high-risk patients undergoing non-cardiac surgery. This study’s objective was to evaluate the FloTrac/EV1000 platform’s efficacy for improving postoperative outcomes in cardiac surgery. Patients and Methods Eighty-six adults undergoing coronary artery bypass graft (CABG) with cardiopulmonary bypass (CPB) in 2 tertiary referral centers were randomized to the EGDT or Control group. The Control group was managed with standard care to achieve the following goals: mean arterial pressure 65–90 mmHg; central venous pressure 8–12 mmHg; urine output ≥0.5 mL·kg −1 ·h −1 ; oxygen saturation >95%; and hematocrit 26–30%. The EGDT group was managed to reach similar goals using information from the FloTrac/EV1000 monitor. The targets were stroke volume variation <13%; stroke volume index 33–65 mL·beat −1 ·m −2 ; cardiac index 2.2–4.0 L·min −1 ·m −2 ; and systemic vascular resistance index 1600–2500 dynes·s·cm -5 ·m -2 . Results The intensive care unit (ICU) stay of the EGDT group was significantly shorter (mean difference −29.5 h; 95% CI −17.2 to −41.8, P < 0.001). The mechanical ventilation time was also shorter in the EGDT group (mean difference −11.3 h; 95% CI −2.7 to −19.9, P = 0.011). The hospital LOS was shorter in the EGDT group (mean difference −1.1 d; 95% CI −0.1 to −2.1, P = 0.038). Conclusion EGDT using FloTrac/EV1000 can be applied in CABG with CPB to improve postoperative outcomes.

Background: Early goal-directed therapy (EGDT) using the FloTrac system reportedly decreased mortality, morbidity, and length of stay (LOS) in intensive care unit (ICU) and hospital among high-risk patients undergoing non-cardiac surgery. The objective of this study was to evaluate the efficacy of the FloTrac/EV1000 platform for improving postoperative outcomes in cardiac surgery. Methods: Eighty-six adults undergoing coronary artery bypass graft (CABG) with cardiopulmonary bypass (CPB) were randomized to the EV1000 or Control group. The Control group was managed with standard care to achieve the following goals: mean arterial pressure 65-90 mmHg; central venous pressure 8-12 mmHg; urine output ≥ 0.5 mL/kg/h; oxygen saturation > 95%; and hematocrit 26-30%. The EV1000 group was managed to reach similar goals using information from the FloTrac/EV1000 monitor. The targets were: stroke volume variation (SVV) < 13%; cardiac index (CI) 2.2-4.0 L/min/m2; stroke volume index (SVI) 33‑65 mL/beat/m2; and systemic vascular resistance index (SVRI) 1600‑2500 dynes/s/cm5/m2. Results: The LOS in ICU of the EV1000 group was significantly shorter (mean difference -29.5 h; 95%CI -17.2 to -41.8, p < 0.001). The mechanical ventilation time was also shorter in the EV1000 group (mean difference -11.3 h; 95%CI -2.7 to -19.9, p = 0.011). The hospital LOS was shorter in the EV1000 group (mean difference -1.1 d; 95%CI -0.1 to -2.1, p =0.038). The EV1000 group received a higher number of inotropic or vasoactive drugs than the Control group in pre-bypass period, but less in post-bypass, postoperative period before transfer to the ICU, and in the ICU. The EV1000 group had less atrial fibrillation with rapid ventricular response, acute respiratory distress syndrome, and acute renal injury.Conclusions: Compared with standard care, intraoperative hemodynamic optimization using the FloTrac/EV1000 platform for the EGDT protocol in patients undergoing CABG with CPB resulted in shorter ventilator time, shorter ICU and hospital LOS, and fewer postoperative complications. The EV1000 group required more fluid and inotropic or vasoactive drugs in the pre-bypass period to optimize SVV, CI, and SVRI and to maintain the target MAP resulting in better myocardium oxygen supply reflected in fewer drugs required during post-bypass, before transfer to, and in, the ICU.Trial registrationThe study was registered with ClinicalTrials.gov (NCT04292951) on 03/03/2020.

Background: Early goal-directed therapy (EGDT) using FloTrac reduced length of stay (LOS) in intensive care (ICU) and hospital among patients undergoing coronary artery bypass graft (CABG) with a cardiopulmonary bypass (CPB). However, this platform in off-pump CABG (OPCAB) has received scant attention, so we evaluated the efficacy of EGDT using FloTrac/EV1000 as a modality for improving postoperative outcomes in patients undergoing OPCAB.Methods: Forty patients undergoing OPCAB were randomized to the EV1000 or Control group. The Control group received fluid, inotropic, or vasoactive drugs (at the discretion of the attending anesthesiologist) to maintain a mean arterial pressure 65-90 mmHg; central venous pressure 8-12 mmHg; urine output ≥ 0.5 mL·kg-1·h-1; SpO2 > 95%; and hematocrit ≥ 30%. The EV1000 group achieved identical targets using information from the FloTrac/EV1000. The goals included stroke volume variation (SVV) < 13%; stroke volume index (SVI) of 33-65 mL·beat-1·m-2 and cardiac index (CI) of 2.2-4.0 L·min-1·m-2; and systemic vascular resistance index (SVRI) of 1,500‑2,500 dynes s-1·cm-5·m-2.Results: The EV1000 group had a shorter LOS in ICU (mean difference -31.6 h, 95% CI -42.8 to -20.3; P < 0.001). The ventilator time for both groups was comparable (P = 0.316), but the hospital stay for the EV1000 group was shorter (mean difference -1.4 d, 95% CI -2.1 to -0.6; P < 0.001).Conclusions: EGDT using FloTrac/EV1000 compared to conventional protocol reduces LOS in ICU and hospital among patients undergoing OPCAB.Trial registration: This study was retrospectively registered at www.ClinicalTrials.gov (NCT04292951) on 3 March 2020.