초록접수 현황
| 14F-035 | 구연 발표 |
Comparison Study of Postoperative Hemodynamic Goal-directed Therapy Using Pulmonary Artery Catheter and Bioreactance-based Noninvasive Cardiac Output Monitoring in Patients with Atrial Fibrillation Undergoing Valvular Heart Surgery
이삭¹, 이승현¹, 장병철¹, 심재광²
Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea1,
Division of Anesthesiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea2
Background : An effective hemodynamic goal-directed therapy (GDT) requires proper feedback of the patient’s volume status. Yet, cardiac filling pressures offer limited information regarding fluid responsiveness and arterial waveform-derived dynamic indices of preload cannot be applied to patients with arrhythmia or spontaneous breathing efforts. The aim of this study was to compare the efficacy of 2 different postoperative GDTs based on conventional pulmonary artery catheter (PAC) versus bioreactance-based Noninvasive Cardiac Output Monitoring (NICOM) coupled with passive leg raising (PLR) in patients with atrial fibrillation undergoing valvular heart surgery (VHS).
Methods : Fifty eight patients were randomized into two groups of GDT with common goals to maintain the mean arterial pressure 60-80 mmHg and cardiac index ≥2 L/min/m2: the PAC group (n = 29); based on pulmonary capillary wedge pressure and the NICOM group (n = 29); based on changes in stroke volume index after PLR. Vasopressors (norepinephrine + vasopressin) and inotropes (milrinone + dobutamine) were used in a stepwise additive fashion. Finally, when the targeted hemodynamic goals could not be achieved, epinephrine was added. Primary endpoint was length of hospital stay (LOS). Secondary endpoints were resource utilization including fluid balance, vasopressors and inotropes requirement, and morbidity endpoints.
Results : The LOS was shorter in the NICOM group without statistical significance (12.2 ± 4.8 days vs. 10.8 ± 4.0 days, p = 0.239). Numbers of patients requiring epinephrine (5 vs. 0, p = 0.019) and ventilator care >24 h (6 vs. 1, p = 0.044) were significantly higher in the PAC group. The PAC group also required significantly larger amount of colloid (1652 ± 519 ml vs. 1143 ± 463 ml, p = 0.004).
Conclusion : NICOM-based postoperative hemodynamic GDT showed promising results in patients with atrial fibrillation undergoing VHS in terms of resource utilization.
Methods : Fifty eight patients were randomized into two groups of GDT with common goals to maintain the mean arterial pressure 60-80 mmHg and cardiac index ≥2 L/min/m2: the PAC group (n = 29); based on pulmonary capillary wedge pressure and the NICOM group (n = 29); based on changes in stroke volume index after PLR. Vasopressors (norepinephrine + vasopressin) and inotropes (milrinone + dobutamine) were used in a stepwise additive fashion. Finally, when the targeted hemodynamic goals could not be achieved, epinephrine was added. Primary endpoint was length of hospital stay (LOS). Secondary endpoints were resource utilization including fluid balance, vasopressors and inotropes requirement, and morbidity endpoints.
Results : The LOS was shorter in the NICOM group without statistical significance (12.2 ± 4.8 days vs. 10.8 ± 4.0 days, p = 0.239). Numbers of patients requiring epinephrine (5 vs. 0, p = 0.019) and ventilator care >24 h (6 vs. 1, p = 0.044) were significantly higher in the PAC group. The PAC group also required significantly larger amount of colloid (1652 ± 519 ml vs. 1143 ± 463 ml, p = 0.004).
Conclusion : NICOM-based postoperative hemodynamic GDT showed promising results in patients with atrial fibrillation undergoing VHS in terms of resource utilization.
책임저자: 이삭
Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
연락처 : 이삭, Tel: 02-2228-8488 , E-mail : sak911@yuhs.ac
