Perioperative Individualized Goal Directed Therapy for Cardiac Surgery: A Historical-Prospective, Comparative Effectiveness Study
| Autor: | Jason Gatling, Manshu Yan, Anees J. Razzouk, David G. Rabkin, Mckinzey Martinez, Ihab Dorotta, Rosario Floridia, Ryan Lauer, Huayong Hu, Davinder Ramsingh |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Inotrope
Mean arterial pressure medicine.medical_specialty Cardiac index lcsh:Medicine goal directed therapy 030204 cardiovascular system & hematology hemodynamic monitoring Article cardiac anesthesia law.invention 03 medical and health sciences 0302 clinical medicine 030202 anesthesiology law adult critical care medicine Cardiopulmonary bypass business.industry lcsh:R General Medicine Perioperative Intensive care unit Cardiac surgery Emergency medicine Milrinone business adult cardiac care medicine.drug |
| Zdroj: | Journal of Clinical Medicine, Vol 10, Iss 400, p 400 (2021) Journal of Clinical Medicine Volume 10 Issue 3 |
| ISSN: | 2077-0383 |
| Popis: | Introduction: Cardiac surgery patients are at increased risk for post-operative complications and prolonged length of stay. Perioperative goal directed therapy (GDT) has demonstrated utility for non-cardiac surgery, however, GDT is not common for cardiac surgery. We initiated a quality improvement (QI) project focusing on the implementation of a GDT protocol, which was applied from the immediate post-bypass period into the intensive care unit (ICU). Our hypothesis was that this novel GDT protocol would decrease ICU length of stay and possibly improve postoperative outcomes. Methods: This was a historical prospective, QI study for patients undergoing cardiac surgery requiring cardiopulmonary bypass (CPB). Integral to the QI project was education towards all associated providers on the concepts related to GDT. The protocol involved identifying patient specific targets for cardiac index and mean arterial pressure. These targets were maintained from the post-CPB period to the first 12 h in the ICU. Statistical comparisons were performed between the year after GDT therapy was launched to the last two years prior to protocol implementation. The primary outcome was ICU length of stay. Results: There was a significant decrease in ICU length of stay when comparing the year after the protocol initiation to years prior, from a median of 6.19 days to 4 days (2017 vs. 2019, p < 0.0001), and a median of 5.88 days to 4 days (2018 vs. 2019, p < 0.0001). Secondary outcomes demonstrated a significant reduction in total administered volumes of inotropic medication(milrinone). All other vasopressors demonstrated no differences across years. Hospital length of stay comparisons did not demonstrate a significant reduction. Conclusion: These results suggest that an individualized goal directed therapy for cardiac surgery patients can reduce ICU length of stay and decrease amount of inotropic therapy. |
| Databáze: | OpenAIRE |
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