Die intensivmedizinische Versorgung herzchirurgischer Patienten: Hämodynamisches Monitoring und Herz-Kreislauf-Therapie S3-Leitlinie der Deutschen Gesellschaft für Thorax-, Herz- und Gefäßchirurgie (DGTHG) und der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI)

Carl, Matthias; Alms, A.; Braun, J.; Dongas, A.; Erb, Joachim M.; Goetz, A.; Göpfert, Matthias; Gogarten, W.; Grosse, Joachim; Heller, Axel R.; Heringlake, Matthias; Kastrup, Marc; Kröner, Anke; Loer, Stephan A.; Marggraf, G.; Markewitz, Andreas; Reuter, M.; Schmitt, D; Schirmer, Uwe; Wiesenack, Christoph; Zwißler, Bernhard; Spies, C.

doi:10.1055/s-2007-964939

Cited by 45 publications

(6 citation statements)

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“…In 2005 the German Society for Thoracic and Cardiovascular Surgery (DGTH) and the German Society for Anaesthesiology and Intensive Care Medicine (DGAI) initiated and then updated S3 guidelines for postoperative intensive care in cardiac surgery patients [12], [13].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2014

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BackgroundManagement of cardiac surgery patients is a very standardized procedure in respective local institutions. Yet only very limited evidence exists concerning optimal indication, safety and efficacy of hemodynamic monitoring catecholamine and fluid therapy.MethodsBetween April and May 2013, all 81 German anaesthesia departments involved in cardiac surgery care were asked to participate in a questionnaire addressing the institutional specific current practice in hemodynamic monitoring, catecholamine and volume therapy.Results51 (63%) questionnaires were completed and returned. All participating centers used basic hemodynamic monitoring (i.e. invasive arterial blood pressure and central venous pressure), supplemented by transesophageal echocardiography. Pulmonary arterial catheter and calibrated trend monitoring devices were also routinely available. In contrast, non-calibrated trend monitoring and esophageal doppler ultrasound devices were not commonly in use. Cerebral oximetry is increasingly emerging, but lacks clear indications. The majority of patients undergoing cardiac surgery, especially in university hospitals, required catecholamines during perioperative care, In case of low cardiac output syndrome, dobutamine (32%), epinephrine (30%) or phosphodiesterase inhibitors (8%) were first choice. In case of hypotension following vasoplegia, norepinephrine (96%) represented the most common catecholamine. 88% of the participating centers reported regular use of colloid fluids, with hydroxyethyl starches (HES) being first choice (64%).ConclusionsChoice of hemodynamic monitoring is homogenous throughout German centers treating cardiac surgery patients. Norepinephrine is the first line catecholamine in cases of decrease in peripheral vascular resistance. However, catecholamine choice for low cardiac output syndrome varies considerably. HES was the primary colloid used for fluid resuscitation. After conduct of this survey, HES use was restricted by European regulatory authorities in critically ill patients and should only be considered as second-line fluid in surgical patients without renal impairment or severe coagulopathy. Large clinical studies addressing catecholamine and fluid therapy in cardiac surgery patients are lacking.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2014

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“…Prompted by the German report in 2005 [4], the German Society of Anesthesiology and Intensive Care Medicine and the German Society of Thoracic and Cardiovascular Surgery published clinical practice guidelines for the postoperative care of the adult cardiac surgical patient [7]. These guidelines have been updated in 2010 [8] and 2018 [1].…”

Section: Introductionmentioning

confidence: 99%

Postoperative management of patients undergoing cardiac surgery in Austria

Menger

Edlinger-Stanger

Dworschak

et al. 2018

Wien Klin Wochenschr

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SummaryBackgroundNo data are currently available regarding the current clinical practice in postoperative care of cardiac surgical patients in Austria.ObjectiveThe study investigated the current intensive care management concerning hemodynamic monitoring and strategies to treat common perioperative disorders of patients after cardiac surgery in Austria.MethodsA survey consisting of 31 questions was sent to intensivists at all 9 hospitals offering cardiac surgery in Austria.ResultsThe response rate was 100%. The mean number of procedures on cardiopulmonary bypass per centre was 722 ± 223. In the majority of cases postoperative critical care is performed by anesthesiologists. Blood gas analysis, pulse oximetry, electrocardiogram, temperature, central venous pressure, arterial pressure and hourly urine output are de facto standard monitoring in all centers. Transesophageal echocardiography is available in all centers and is frequently used. Crystalloids are the first choice for volume replacement, whereas levosimendan and adrenaline are employed for the treatment of low cardiac output syndrome.ConclusionsThis study provides insights into the current state of postoperative management of cardiac surgical patients in Austria. Standard monitoring as proposed by international guidelines is well established in Austrian intensive care units. Echocardiography is widely seen as a very important tool in the postoperative care of cardiac surgical patients. Knowledge about the status quo of postoperative intensive care management of cardiac surgical patients enables further development of patient care.Electronic supplementary materialThe online version of this article (10.1007/s00508-018-1403-3) contains supplementary material, which is available to authorized users.

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“…The combination preparation increases mean arterial pressure (MAP), cardiac stroke volume and cardiac output [ 18 , 25 ]. Compared to alpha-adrenergic sympathomimetic agents, cafedrine/theodrenaline was shown to cause less deterioration of renal, cerebral and coronary perfusion [ 5 ]. In addition, clinical practice with alpha-adrenergic sympathomimetic agents requires measures to control refectory critical bradycardia, for example with atropine [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Cafedrin/Theodrenalin in der Anästhesie

et al. 2015

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BackgroundHypotensive states that require fast stabilisation of blood pressure can occur during anaesthesia. In 1963, the 20:1 mixture of cafedrine/theodrenaline (Akrinor®) was introduced in Germany for use in anaesthesia and emergency medicine in the first-line management of hypotensive states. Though on the market for many years, few pharmacodynamic data are available on this combination net beta-mimetic agent.AimThis study aimed to examine the drug combination in real-life clinical practice and recorded time to 10 % mean arterial blood pressure (MAP) increase and heart rate. Furthermore, potential factors that influence drug effectiveness under anaesthesia were assessed.MethodsData were collected within a standardised anaesthesia protocol. A total of 353 consecutive patients (female/male = 149/204) who received cafedrine/theodrenaline after a drop in MAP ≥ 5 % were included in the study. The time to 10 % increase in MAP, dosage of cafedrine/theodrenaline, volume loading, blood pressure and heart rate were monitored over time.ResultsPatients were a mean (standard deviation) of 64.4 ± 15.1 years old with a baseline MAP of 82 ± 14 mmHg, which dropped to a mean of 63 ± 10 mmHg during anaesthesia without gender differences. Cafedrine/theodrenaline (1.27 ± 1.0 mg/kg; 64 ± 50 µg/kg) significantly increased MAP (p < 0.001) by 11 ± 16 mmHg within 5 min, reaching peak values within 17.4 ± 9.0 min. Heart rate was not affected in a clinically significant manner. Cafedrine/theodrenaline induced a 10 % MAP increase after 7.2 ± 4.6 min (women) and after 8.6 ± 6.3 min (men) (p = 0.018). Independent of gender, the dose of cafedrine/theodrenaline required to achieve the observed MAP increase of 14 ± 16 mmHg at 15 min was significantly different in patients with heart failure [1.78 ± 1.67 mg/kg (cafedrine)/89.0 ± 83.5 µg/kg (theodrenaline)] compared with healthy patients [1.16 ± 0.77 mg/kg (cafedrine)/58.0 ± 38.5 µg/kg (theodrenaline)] (p = 0.005). Concomitant medication with beta-blocking agents significantly prolonged the time to 10 % MAP increase [9.0 ± 7.0 vs. 7.3 ± 4.3 min (p = 0.008)].ConclusionCafedrine/theodrenaline quickly restores MAP during anaesthesia. Female gender is associated with higher effectiveness, while heart failure and beta-blocker administration lower the anti-hypotonic effect. Prospective studies in defined patient populations are warranted to further characterise the effect of cafedrine/theodrenaline.

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Die intensivmedizinische Versorgung herzchirurgischer Patienten: Hämodynamisches Monitoring und Herz-Kreislauf-Therapie S3-Leitlinie der Deutschen Gesellschaft für Thorax-, Herz- und Gefäßchirurgie (DGTHG) und der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI)

Cited by 45 publications

References 0 publications

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

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

Postoperative management of patients undergoing cardiac surgery in Austria

Cafedrin/Theodrenalin in der Anästhesie

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