Efficacy of early goal-directed therapy using FloTrac/EV1000 to improve postoperative outcomes in patients undergoing off-pump coronary artery bypass surgery: a randomized controlled trial

Abstract

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. 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 < 13%; cardiac index (CI) of 2.2–4.0 L min−1 m−2; and systemic vascular resistance index of 1500–2500 dynes s−1 cm−5 m−2. Results The EV1000 group had a shorter LOS in ICU (mean difference − 1.3 d, 95% CI − 1.8 to − 0.8; 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.

Goal-directed therapy guided by the FloTrac sensor in major surgery: a systematic review and meta-analysis

“…Martin et al (35) United Kingdom Patients between 18 and 80 years old diagnosed with liver cirrhosis and undergoing liver transplantation Mayer et al (36) Germany ASA III patients with 2 or more risk factors undergoing major open abdominal surgery (intestinal/stomach/liver/esophagus resection, Whipple procedure) Mishra et al (37) India ASA I-II patients between 18 and 65 years old with large supratentorial tumors undergoing elective craniotomy and excision Parke et al (38) New Zealand Patients aged 16 or older, classified with EuroSCORE II of 0.9 or more, undergoing elective cardiac surgery Peng et al (39) China Patients undergoing major orthopedic surgeries, including hip arthroplasty, spinal fusion, femur fracture, and sacral tumor Ramsingh et al (40) United States Patients undergoing major abdominal surgeries Scheeren et al (41) Germany ASA III-IV adult patients undergoing high-risk surgery Sujatha et al (42) India ASA I-II patients between 20 and 70 years old undergoing elective intestinal surgery Tribuddharat et al (43) Thailand ASA II-IV adult patients undergoing saphenous vein graft surgery Tribuddharat et al (44) Thailand ASA II-III patients undergoing saphenous vein graft surgery Van der Linde et al (45) Belgium ASA II-III patients undergoing coronary artery bypass surgery de Waal et al (46) Netherlands Patients undergoing high-risk abdominal surgery such as esophagectomy, duodenopancreatectomy, repair of abdominal aneurysm, resection of tissues with malignancy classified above III Weinberg et al (47) Australia Adult patients undergoing major elective liver resection surgery Zhang et al (48) China ASA I-II patients between 18 and 60 years old undergoing thoracoscopic lobectomy surgery under mechanical ventilation of one lung Zhao et al (49) China ASA II-III patients above 60 years old undergoing major abdominal cancer surgery Zheng et al (50) China Patients between 60 and 80 years old with coronary heart disease and undergoing gastrointestinal surgery…”

Intraoperative Goal-Directed Perfusion in Cardiac Surgery with Cardiopulmonary Bypass: The Roles of Delivery Oxygen Index and Cardiac Index

“…This achievement can be attributed to the optimization of myocardial perfusion through the monitoring of SVV, CI, and SVRI using inotropic and vasoactive support. 32) GDP has proven advantageous in postoperative cardiac surgery patients, particularly in the ICU. A study employed SVV >10% on the pulmonary artery catheter for maintenance strategies, optimizing hemodynamic parameters, resulting in quicker recovery, lower complication rates, shorter inotropic agent use, and reduced ICU and hospital stays.…”