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- Title
Monitoring dynamic arterial elastance as a means of decreasing the duration of norepinephrine treatment in vasoplegic syndrome following cardiac surgery: a prospective, randomized trial.
- Authors
Guinot, Pierre-Grégoire; Abou-Arab, Osama; Guilbart, Mathieu; Bar, Stéphane; Zogheib, Elie; Daher, Mona; Besserve, Patricia; Nader, Joseph; Caus, Thierry; Kamel, Said; Dupont, Hervé; Lorne, Emmanuel; Guinot, Pierre-Grégoire; Bar, Stéphane; Dupont, Hervé
- Abstract
<bold>Purpose: </bold>To evaluate the ability of an algorithm based on dynamic arterial elastance to decrease the duration of norepinephrine treatment.<bold>Methods: </bold>We performed a prospective, open-label, randomized study in patients requiring norepinephrine for vasoplegic syndrome after cardiac surgery with cardiopulmonary bypass. Patients were randomized to an algorithm-based intervention group or a control group. The primary outcome was the duration of norepinephrine treatment. The secondary outcomes included the total dose of norepinephrine, the length of stay (LOS) in the ICU, central venous oxygen saturation, arterial lactate levels, arrhythmia and diuresis.<bold>Results: </bold>Of 130 included patients, 118 were analysed on an intention-to-treat basis (intervention group: n = 59; control group: n = 59). On inclusion, the intervention and control groups did not differ significantly in terms of demographic characteristics, surgical data or the prior duration of norepinephrine treatment [5 h (4-10) vs. 5 h (5-7), respectively; P = 0.543]. The cumulative duration of norepinephrine treatment after inclusion was shorter in the intervention group than in the control group [17 h (13-26)] vs. 39 h (19-58), respectively; (P < 0.001). The cumulative dose of norepinephrine and the LOS in the ICU were also lower in the intervention group (P < 0.05). There were no intergroup differences for other outcomes (the sepsis-related organ failure score, central venous oxygen saturation, arrhythmia, and arterial lactate levels).<bold>Conclusion: </bold>A haemodynamic algorithm based on dynamic arterial elastance was associated with a shorter duration of norepinephrine treatment and a shorter LOS in the ICU. Use of the algorithm did not alter perfusion parameters or increase the volume of fluid infused. ClinicalTrials.gov Identifier: NCT02479529.
- Subjects
NORADRENALINE; TREATMENT duration; TREATMENT of vascular diseases; CARDIOPULMONARY bypass; LENGTH of stay in hospitals; THERAPEUTICS; ALGORITHMS; ARTERIES; VASCULAR diseases; CLINICAL trials; COMPARATIVE studies; CARDIAC surgery; HEMODYNAMICS; INTENSIVE care units; LACTIC acid; LONGITUDINAL method; RESEARCH methodology; MEDICAL cooperation; RESEARCH; TIME; VASOCONSTRICTORS; EVALUATION research; RANDOMIZED controlled trials; CASE-control method
- Publication
Intensive Care Medicine, 2017, Vol 43, Issue 5, p643
- ISSN
0342-4642
- Publication type
journal article
- DOI
10.1007/s00134-016-4666-z