Goal-directed fluid management reduces vasopressor and catecholamine use in cardiac surgery patients

Goepfert, Matthias S.; Reuter, Daniel A.; Akyol, Derya; Lamm, Peter; Kilger, Erich; Goetz, Alwin E.

doi:10.1007/s00134-006-0404-2

Cited by 235 publications

(140 citation statements)

References 34 publications

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“…These systems are therefore suitable for use in high-risk surgery or the intensive care unit (ICU). Goal-directed intraoperative hemodynamic optimization using the PiCCO has been shown to decrease requirement for inotropes/vasopressors and shorten mechanical ventilation time in patients undergoing routine cardiac surgery [30]. Pearse et al used the LiDCOplus system (LiDCO Ltd, Cambridge, UK) to optimize high-risk surgical patients postoperatively, using a combination of colloid and inotropes [31].…”

Section: Does Gdft Improve Outcomes?mentioning

confidence: 99%

State-of-the-art fluid management in the operating room

Miller

Raghunathan

Gan

2014

Best Practice & Research Clinical Anaesthesiology

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The underlying principles guiding fluid management in any setting are very simple: maintain central euvolemia, and avoid salt and water excess. However, these principles are frequently easier to state than to achieve. Evidence from recent literature suggests that avoidance of fluid excess is important, with excessive crystalloid use leading to perioperative weight gain and an increase in complications. A zero-balance approach aimed at avoiding fluid excess is recommended for all patients. For major surgery, there is a sizeable body of evidence that an individualized goal-directed fluid therapy (GDFT) improves outcomes. However, within an Enhanced Recovery program only a few studies have been published, yet so far GDFT has not achieved the same benefit. Balanced crystalloids are recommended for most patients. The use of colloids remains controversial; however, current evidence suggests they can be beneficial in intraoperative patients with objective evidence of hypovolemia.

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Section: Does Gdft Improve Outcomes?mentioning

confidence: 99%

State-of-the-art fluid management in the operating room

Miller

Raghunathan

Gan

2014

Best Practice & Research Clinical Anaesthesiology

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“…There is good evidence regarding the efficacy of goal-directed fluid management based on transpulmonary thermodilution-measured variables using the PiCCO Ò monitoring system (Pulsion Medical Systems, Munich, Germany) [14][15][16]. This has been shown to provide optimal volume management for critically ill patients with necrotising pancreatitis [15], and to reduce the vasopressor requirements of cardiac surgery patients [14].…”

mentioning

confidence: 99%

“…This has been shown to provide optimal volume management for critically ill patients with necrotising pancreatitis [15], and to reduce the vasopressor requirements of cardiac surgery patients [14]. Furthermore, this system allows estimation of extravascular lung water and the pulmonary vascular permeability index, which may be used to assess the severity of pulmonary dysfunction.…”

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confidence: 99%

The precision of PiCCO^®measurements in hypothermic post‐cardiac arrest patients

Tagami

Kushimoto

Tosa³

et al. 2012

Anaesthesia

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SummaryThe aim of the present study was to determine the precision of the PiCCO Ò system for post-cardiac arrest patients who underwent therapeutic hypothermia. The precision of the measurements for cardiac output, global end-diastolic volume, extravascular lung water and the pulmonary vascular permeability index was assessed using the least significant change; this was regarded as precise when less than 15%. A total of 462 measurement sets were prospectively performed on 88 patients following successful resuscitation after cardiac arrest. Using the mean value of three injections for a measurement, the least significant change for the cardiac output, global end-diastolic volume, extravascular lung water and pulmonary vascular permeability index measurements were found to be 7.8%, 8.5%, 7.8% and 12.1%, respectively. No significant differences between hypothermia (n = 150) and non-hypothermia (n = 312) were found. The PiCCO-derived variables were found to be precise for post-cardiac arrest patients even under conditions of varying body temperature.

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“…By virtue of its design, the study did not address the potential clinical benefits of one hemodynamic monitoring technique over the other. Although our results were obtained by thermal-dye dilution, the current standard is single transpulmonary thermodilution (PiCCO™ technique) [10,34], because double and single dilution methods yield similar values for GEDVI. Hence, our results should also be applied to single transpulmonary thermodilution.…”

Section: Discussionmentioning

confidence: 99%

Cardiac filling volumes versus pressures for predicting fluid responsiveness after cardiovascular surgery: the role of systolic cardiac function

et al. 2011

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IntroductionStatic cardiac filling volumes have been suggested to better predict fluid responsiveness than filling pressures, but this may not apply to hearts with systolic dysfunction and dilatation. We evaluated the relative value of cardiac filling volume and pressures for predicting and monitoring fluid responsiveness, according to systolic cardiac function, estimated by global ejection fraction (GEF, normal 25 to 35%) from transpulmonary thermodilution.MethodsWe studied hypovolemic, mechanically ventilated patients after coronary (n = 18) or major vascular (n = 14) surgery in the intensive care unit. We evaluated 96 colloid fluid loading events (200 to 600 mL given in three consecutive 30-minute intervals, guided by increases in filling pressures), divided into groups of responding events (fluid responsiveness) and non-responding events, in patients with low GEF (<20%) or near-normal GEF (≥20%). Patients were monitored by transpulmonary dilution and central venous (n = 9)/pulmonary artery (n = 23) catheters to obtain cardiac index (CI), global end-diastolic volume index (GEDVI), central venous (CVP) and pulmonary artery occlusion pressure (PAOP).ResultsFluid responsiveness occurred in 8 (≥15% increase in CI) and 17 (≥10% increase in CI) of 36 fluid loading events when GEF was <20%, and 7 (≥15% increase in CI) and 17 (≥10% increase in CI) of 60 fluid loading events when GEF was ≥20%. Whereas a low baseline GEDVI predicted fluid responsiveness particularly when GEF was ≥20% (P = 0.002 or lower), a low PAOP was of predictive value particularly when GEF was <20% (P = 0.004 or lower). The baseline CVP was lower in responding events regardless of GEF. Changes in CVP and PAOP paralleled changes in CI particularly when GEF was <20%, whereas changes in GEDVI paralleled CI regardless of GEF.ConclusionsRegardless of GEF, CVP may be useful for predicting fluid responsiveness in patients after coronary and major vascular surgery provided that positive end-expiratory pressure is low. When GEF is low (<20%), PAOP is more useful than GEDVI for predicting fluid responsiveness, but when GEF is near-normal (≥20%) GEDVI is more useful than PAOP. This favors predicting and monitoring fluid responsiveness by pulmonary artery catheter-derived filling pressures in surgical patients with systolic left ventricular dysfunction and by transpulmonary thermodilution-derived GEDVI when systolic left ventricular function is relatively normal.

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Goal-directed fluid management reduces vasopressor and catecholamine use in cardiac surgery patients

Abstract: Guiding therapy by an algorithm based on GEDVI leads to a shortened and reduced need for vasopressors, catecholamines, mechanical ventilation, and ICU therapy in patients undergoing cardiac surgery.

Cited by 235 publications

References 34 publications

State-of-the-art fluid management in the operating room

State-of-the-art fluid management in the operating room

The precision of PiCCO^®measurements in hypothermic post‐cardiac arrest patients

Cardiac filling volumes versus pressures for predicting fluid responsiveness after cardiovascular surgery: the role of systolic cardiac function

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Goal-directed fluid management reduces vasopressor and catecholamine use in cardiac surgery patients

Abstract: Guiding therapy by an algorithm based on GEDVI leads to a shortened and reduced need for vasopressors, catecholamines, mechanical ventilation, and ICU therapy in patients undergoing cardiac surgery.

Cited by 235 publications

References 34 publications

State-of-the-art fluid management in the operating room

State-of-the-art fluid management in the operating room

The precision of PiCCO®measurements in hypothermic post‐cardiac arrest patients

Cardiac filling volumes versus pressures for predicting fluid responsiveness after cardiovascular surgery: the role of systolic cardiac function

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The precision of PiCCO^®measurements in hypothermic post‐cardiac arrest patients