Length of ICU stayreduced by

32%

Complications reduced by

36%

Optimized Hemodynamic Therapy in Cardiac Surgery Patients

32%36%

Early goal-directed therapy reduces intensive care stay after cardiac surgery

Extravascular Lung Water Index (ELWI) can serve as a warning parameter for volume overload

Fluid Management: timing is everything!

Individualise your treatment

Control Group Control GroupStudy Group Study Group

Authors GoepfertMS,RichterHP,EulenburgCZ,GruetzmacherJ,RafflenbeulE,RoeherK, Sandersleben AV, Diedrichs S, Reichenspurner H, Goetz AE, Reuter DACenter Hamburg-Eppendorf, GermanyJournal Anesthesiology 2013; epubStudy Type Prospective Randomised Controlled TrialHypothesis Goal-directed hemodynamic therapy, based on the combination of functional and volumetric hemodynamic parameters, improves outcome in patients with cardiac surgery.Surgeries Coronary Artery Bypass Grafting (CABG), Aortic Valve Replacement (AVR), CABG + AVRTechnology PiCCO Monitor with PiCCO femoral artery catheter Study Group (SG) Control Group (CG) No of patients 50 50 GDT parameters SVV, GEDI, ELWI, CI, MAP MAP, CVP, HR

Individually Optimized Hemodynamic Therapy Reduces Complications and Length of Stay in the Intensive Care Unit A Prospective, Randomised Controlled Trial

P

ULS

ION

11/

2013

M

PI4

105U

S_R

00

STOP

SVV10%

Give volume until SVV10%

(observe CI and ELWI)

ELWI > 12 ml/kg or CI decreasing

Consider diuretics

Define optimal GEDI

YES

NO

MAP > 65 [mmHg]

YES

NO

HR > 50 [bpm]

YES HR < 110 [bpm]

YES OK

CVP > 8 [mmHg]

NO

Pacing Orciprenaline

Atropine

NO

Sedation Analgesia

RBC Transfusion -Blockade

AntiarrhytmicsNO YES

Give volume until MAP > 65 [mmHg] or

CVP > 8 [mmHg]

Vasopressors Catecholamines

Optimal GEDI reached or SVV10%

YES

NO

CI > 2.0 [l/min/m-2]

MAP > 65 [mmHg]

Give volume until opt GEDI is reached

orSVV10% (observe CI and ELWI)

NO

HR < 50 [bpm]

NO

Vasopressor

HR 50-100 [bpm]

NO

Pacing Orciprenaline

Atropine Analgesia Sedation

-Blockers RBC Transfusion

STOP

ELWI > 12 ml/kg or CI decreasing

Consider diuretics

YESYES

YES

Pacing 90/min Orciprenaline

Atropine

NO

Catecholamines

Algorithm 1: SVV was used to optimize preload. After volume optimization, GEDI was measured and noted as optGEDI. Algorithm 2: The individually titrated optGEDI served as the goal for preload optimization in clinical situations where SVV was not feasible.

Algorithm 3: Hemodynamic algorithm for patients in the control group

Control Group

Study Group

GDT Goal Directed TherapySVV Stroke Volume VariationGEDI Global End-Diastolic Volume IndexELWI Extravascular Lung Water IndexCI Cardiac IndexMAP Mean Arterial PressureCVP Central Venous PressureHR Heart Rate

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