Goal-directed therapy for decompensated heart failure and renal dysfunction. A pilot randomized clinical trial
| Autor: | Jaime Freitas Bastos, Liliane Kopel, Mauricio Ferri, José Jayme Galvão de Lima, Silvia G. Lage |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Pulmonary artery catheter heart failure lcsh:Medicine Hemodynamics Renal function Heart failure 030204 cardiovascular system & hematology law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Internal medicine Medicine Monitoring hemodynamic pulmonary artery catheter Cardiogenic shock lcsh:R5-920 business.industry cardiogenic shock lcsh:R Acute kidney injury 030208 emergency & critical care medicine medicine.disease Surgery monitoring hemodynamic acute kidney injury Cardiology lcsh:Medicine (General) business Central venous catheter |
| Zdroj: | MedicalExpress v.3 n.2 2016 MedicalExpress (São Paulo. Online) Mavera Edições Científicas e Técnicas Ltda-ME instacron:METC Medical Express, Vol 3, Iss 2 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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