Goal-directed therapy for decompensated heart failure and renal dysfunction. A pilot randomized clinical trial

Abstract

OBJECTIVES:Acute heart failure is associated with low cardiac output syndrome and renal dysfunction. However, it is not known whether a goal-directed protocol guided by tightly controlled hemodynamic variables, including pulmonary artery catheter, will safely improve clinical renal dysfunction markers in these patients when compared to a less invasive approach. METHODS: Pilot, randomized clinical trial aimed at patients with known heart failure, low cardiac output syndrome and renal dysfunction with less than 48 hours from onset. We randomized two groups: (a) goal-directed therapy monitored with pulmonary artery catheter and (b) conventional therapy with central venous catheter. Hemodynamic parameters, venous oxygen saturation, serum lactate, fluid repositions and vasoactive drugs were compared considering renal function improvement after 72 hours as the primary study endpoint. We included 15 goal-directed therapy and 16 conventional therapy patients. The study has assessed patients on baseline looking for significant improvement at 72 hours of the following parameters in the goal-directed therapy and conventional therapy groups: urine output, serum creatinine, venous oxygen saturation and serum lactate. RESULTS: Baseline characteristics were similar in both groups. In the first 24 hours there was a lower volume of fluid reposition in the goal-directed therapy group, although 72 hours later such reposition was equivalent. The use of inotropic agents was similar between groups. There was an improvement to the renal function and the hemodynamic parameter in both study groups. CONCLUSIONS: The option for the protocol with pulmonary artery catheter setting is justified only if there is clinical evidence of serious pulmonary congestion associated to low peripheral perfusion.

Comparison of goal-directed and standard therapy for hemodynamic management in heart transplantation surgery

“…However, despite lesser fluid in the GDT group, Bastos's study showed no difference in in-hospital stay of both groups. 21 In the present study, the amount of fluid used in the standard group was higher. The Bastos study 21 observed this on the first day after surgery.…”

“…Maintaining cardiac output was compensated by inotropy instead of increasing fluid intake, and ultimately patients' outcomes were better, and hospital stays were reported to be shorter. In Bastos's study, 21 the dose of inotropic (dobutamine) was the same in both groups. In our study, the number of blood products received was also recorded and evaluated, which showed a significant difference only in the case of platelets.…”

Aspectos epidemiológicos, clínicos e assistenciais da monitorização hemodinâmica invasiva: uma revisão bibliográfica

“…Perfil do resumo da amostra encontrada conforme variáveis utilizadas para análise das publicações localizadas nas bases de dados online. 1,2,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19 aferido em numerosas situações clínicas, cirúrgicas e experimentais. Para sua realização, utiliza-se um CVC aplicado preferencialmente na veia jugular.…”

“…Para sua realização, utiliza-se um CVC aplicado preferencialmente na veia jugular. 9 A medida da PVC é um dos primeiros passos na avaliação da volemia e da função cardíaca de pacientes graves. A PVC pode contribuir para avaliação e controle do estado do volume intravascular.…”

Perfil epidemiológico, aptidão cardiopulmonar e qualidade de vida relacionada à saúde de pacientes com insuficiência cardíaca

“…Atribui-se essa diferença ao maior engajamento das mulheres em ações preventivas e de controle de saúde, adoção de hábitos de vida mais saudáveis, ao contrário dos homens que se caracterizam pela busca tardia ao serviço de saúde e por terem um estilo de vida de maior risco cardiovascular apresentando-se muitas vezes em estágios descompensados e/ou mais avançados de IC. Estes aspectos não foram alvo deste estudo (BRASIL, 2008;PILGER;MENON;MATHIAS, 2011;BASTOS, 2016;DE ALMEIDA NETO et al, 2016, AHMETI et al, 2017.…”