Premium
Single transpulmonary thermodilution and continuous monitoring of central venous oxygen saturation during off‐pump coronary surgery
Author(s) -
SMETKIN A. A.,
KIROV M. Y.,
KUZKOV V. V.,
LENKIN A. I.,
EREMEEV A. V.,
SLASTILIN V. Y.,
BORODIN V. V.,
BJERTNAES L. J.
Publication year - 2009
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/j.1399-6576.2008.01855.x
Subject(s) - medicine , hemodynamics , perioperative , cardiac index , central venous pressure , anesthesia , artery , mean arterial pressure , cardiac output , cardiology , dobutamine , heart rate , blood pressure
Background: Off‐pump coronary artery bypass grafting (OPCAB) requires thorough monitoring of hemodynamics and oxygen transport. Our aim was to find out whether therapeutic guidance during and after OPCAB, using an algorithm based on advanced monitoring, influences perioperative hemodynamic and fluid management as well as the length of post‐operative ICU and hospital stay. Methods: Patients were randomized into two groups of hemodynamic monitoring: the conventional monitoring (CM) group ( n =20) and the advanced monitoring (AM) group ( n =20). In the CM group, therapy was guided by central venous pressure, mean arterial pressure (MAP) and heart rate (HR), and in the AM group by the intrathoracic blood volume index, MAP, HR, central venous oxygen saturation (ScvO 2 ) and cardiac index (CI). The measurements were performed before and during surgery, and at 2, 4 and 6 h post‐operatively. Results: In the AM group, colloids and dobutamine were given more frequently and were accompanied by increments in ScvO 2 , CI and oxygen delivery compared with baseline. The percentage of ephedrine administration was higher in the CM group. The algorithm guided by AM decreased time until achieving the status of ‘fit for ICU discharge’ and post‐operative hospital stay by 15% and 25%, respectively. Conclusions: A goal‐directed algorithm based on advanced hemodynamic monitoring and continuous measurement of ScvO 2 facilitates early detection and correction of hemodynamic changes and influences the strategy for fluid therapy that can improve the course of post‐operative period after coronary artery bypass grafting on the beating heart.