Catecholamine and Volume Therapy for Cardiac Surgery in Germany – Results from a Postal Survey

Sponholz, Christoph; Schelenz, C; Reinhart, Konrad; Schirmer, Uwe; Stehr, Sebastian

doi:10.1371/journal.pone.0103996

Cited by 28 publications

(29 citation statements)

References 30 publications

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“…Nevertheless, in a recent survey performed in cardiothoracic intensive care units (ICUs) in Italy, CVP was reported to be the parameter most frequently used to monitor fluid therapy in critically ill patients and during the perioperative period in cardiac surgery [6]. Similar findings have been reported in a consistent number of studies performed in different parts of the world in both adult and pediatric patients [7][8][9]. Although practice might be changing, particularly in the general ICU setting [10], it seems that there is still a relevant gap between research and everyday clinical practice.…”

Section: Introductionsupporting

confidence: 53%

Central Venous Pressure as a Predictor of Fluid Responsiveness: Is This All You Need?

Guarnieri¹,

Belletti²

2016

Gen Med

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Fluid administration during and after surgery is a fundamental strategy for maintaining hemodynamic stability. Technology offers different strategies for hemodynamic monitoring and decision making about fluids administration. In particular patients may be divided into fluid-responding patients and non-fluid-responding patients. Central venous pressure, measured by a central venous catheter, is a basic measure of right heart preload, and many trials defined it as a non-trustable parameter, with many biases and confounding factors, such as mechanical ventilation and intrathoracic pressure. Nevertheless, many authors describe how a simple value like the Central venous pressure may be useful in hemodynamic monitoring during and after cardiac surgery, although it is not the best available. Moreover the results of a recent survey performed in cardiothoracic intensive care units in Italy, reported how central venous pressure was the easiest and the most frequently used parameter for the monitoring of fluid therapy. Given this state of the art, Central venous pressure seems to be the most criticized but, due to its feasibility and availability, it is still the most used parameter for the evaluation of preload and for the prediction of fluid responsiveness in operating room and Intensive Care Unit.

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Section: Introductionsupporting

confidence: 53%

Central Venous Pressure as a Predictor of Fluid Responsiveness: Is This All You Need?

Guarnieri¹,

Belletti²

2016

Gen Med

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“…Low cardiac output syndrome is frequent after cardiac surgery, and a constant challenge for cardiac anesthesiologists and intensivists [ 2 ]. In an effort to avoid low cardiac output syndrome and its implications, standard management in many centers includes administering inotropes to all patients undergoing cardiac surgery [ 3 – 5 ]. A report from the Society of Thoracic Surgeons described how in the United States, more than 90% of patients undergoing coronary artery bypass graft surgery received vasoactive therapies [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Dobutamine-sparing versus dobutamine-to-all strategy in cardiac surgery: a randomized noninferiority trial

Franco

Almeida

Landoni

et al. 2021

Ann. Intensive Care

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Background The detrimental effects of inotropes are well-known, and in many fields they are only used within a goal-directed therapy approach. Nevertheless, standard management in many centers includes administering inotropes to all patients undergoing cardiac surgery to prevent low cardiac output syndrome and its implications. Randomized evidence in favor of a patient-tailored, inotrope-sparing approach is still lacking. We designed a randomized controlled noninferiority trial in patients undergoing cardiac surgery with normal ejection fraction to assess whether an dobutamine-sparing strategy (in which the use of dobutamine was guided by hemodynamic evidence of low cardiac output associated with signs of inadequate tissue perfusion) was noninferior to an inotrope-to-all strategy (in which all patients received dobutamine). Results A total of 160 patients were randomized to the dobutamine-sparing strategy (80 patients) or to the dobutamine-to-all approach (80 patients). The primary composite endpoint of 30-day mortality or occurrence of major cardiovascular complications (arrhythmias, acute myocardial infarction, low cardiac output syndrome and stroke or transient ischemic attack) occurred in 25/80 (31%) patients of the dobutamine-sparing group (p = 0.74) and 27/80 (34%) of the dobutamine-to-all group. There were no significant differences between groups regarding the incidence of acute kidney injury, prolonged mechanical ventilation, intensive care unit or hospital length of stay. Discussion Although it is common practice in many centers to administer inotropes to all patients undergoing cardiac surgery, a dobutamine-sparing strategy did not result in an increase of mortality or occurrence of major cardiovascular events when compared to a dobutamine-to-all strategy. Further research is needed to assess if reducing the administration of inotropes can improve outcomes in cardiac surgery. Trial registration ClinicalTrials.gov, NCT02361801. Registered Feb 2nd, 2015. https://clinicaltrials.gov/ct2/show/NCT02361801

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“…Volume replacement strategies and type of fluid used in patients undergoing cardiac surgery have changed over the years [6]. Safety concerns regarding the use of synthetic colloid solutions in cardiac surgery patients [2, 7, 8] have led to increased use of crystalloid infusions [6, 9, 10].…”

Section: Introductionmentioning

confidence: 99%

Fluid management in patients undergoing cardiac surgery: effects of an acetate- versus lactate-buffered balanced infusion solution on hemodynamic stability (HEMACETAT)

et al. 2019

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Background Recent evidence suggests that acetate-buffered infusions result in better hemodynamic stabilization than 0.9% saline in patients undergoing major surgery. The choice of buffer in balanced crystalloid solutions may modify their hemodynamic effects. We therefore compared the inopressor requirements of Ringer’s acetate and lactate for perioperative fluid management in patients undergoing cardiac surgery. Methods Using a randomized controlled double-blind design, we compared Ringer’s acetate (RA) to Ringer’s lactate (RL) with respect to the average rate of inopressor administered until postoperative hemodynamic stabilization was achieved. Secondary outcomes were the cumulative dose of inopressors, the duration of inopressor administration, the total fluid volume administered, and the changes in acid-base homeostasis. Patients undergoing elective valvular cardiac surgery were included. Patients with severe cardiac, renal, or liver disease were excluded from the study. Results Seventy-five patients were randomly allocated to the RA arm, 73 to the RL. The hemodynamic profiles were comparable between the groups. The groups did not differ with respect to the average rate of inopressors (RA 2.1 mcg/kg/h, IQR 0.5–8.1 vs. RL 1.7 mcg/kg/h, IQR 0.7–8.2, p = 0.989). Cumulative doses of inopressors and time on individual and combined inopressors did not differ between the groups. No differences were found in acid-base parameters and their evolution over time. Conclusion In this study, hemodynamic profiles of patients receiving Ringer’s lactate and Ringer’s acetate were comparable, and the evolution of acid-base parameters was similar. These study findings should be evaluated in larger, multi-center studies. Trial registration Clinicaltrials.gov NCT02895659 . Registered 16 September 2016. Electronic supplementary material The online version of this article (10.1186/s13054-019-2423-8) contains supplementary material, which is available to authorized users.

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Catecholamine and Volume Therapy for Cardiac Surgery in Germany – Results from a Postal Survey

Cited by 28 publications

References 30 publications

Central Venous Pressure as a Predictor of Fluid Responsiveness: Is This All You Need?

Central Venous Pressure as a Predictor of Fluid Responsiveness: Is This All You Need?

Dobutamine-sparing versus dobutamine-to-all strategy in cardiac surgery: a randomized noninferiority trial

Fluid management in patients undergoing cardiac surgery: effects of an acetate- versus lactate-buffered balanced infusion solution on hemodynamic stability (HEMACETAT)

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