Early goal-directed therapy based on endotracheal bioimpedance cardiography: a prospective, randomized controlled study in coronary surgery

Verfasser / Beitragende:
[Jean-Luc Fellahi, David Brossier, Fabien Dechanet, Marc-Olivier Fischer, Vladimir Saplacan, Jean-Louis Gérard, Jean-Luc Hanouz]
Ort, Verlag, Jahr:
2015
Enthalten in:
Journal of Clinical Monitoring and Computing, 29/3(2015-06-01), 351-358
Format:
Artikel (online)
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024 7 0 |a 10.1007/s10877-014-9611-5  |2 doi 
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245 0 0 |a Early goal-directed therapy based on endotracheal bioimpedance cardiography: a prospective, randomized controlled study in coronary surgery  |h [Elektronische Daten]  |c [Jean-Luc Fellahi, David Brossier, Fabien Dechanet, Marc-Olivier Fischer, Vladimir Saplacan, Jean-Louis Gérard, Jean-Luc Hanouz] 
520 3 |a The objective was to compare the impact of an early goal-directed hemodynamic therapy based on cardiac output monitoring (Endotracheal Cardiac Output Monitor, ECOM) with a standard of care on postoperative outcome following coronary surgery. This prospective, controlled, parallel-arm trial randomized 100 elective primary coronary artery bypass grafting patients to a study group (ECOM; n=50) or a control group (control; n=50). In the ECOM group, hemodynamic therapy was guided by respiratory stroke volume variation and cardiac index given by the ECOM system. A standard of care was used in the control. Goal-directed therapy was started immediately after induction of anesthesia and continued until arrival in the intensive care unit (ICU). The primary endpoint was the time when patients fulfilled discharge criteria from hospital (possible hospital discharge). Secondary endpoints were the hospital discharge, the time to reach extubation, the length of stay in ICU, the number of major adverse cardiac events, and in-hospital mortality. Patients in the ECOM group received more often fluid loading and dobutamine. The time to reach extubation was reduced in the ECOM group: 510min [360-1,110] versus 570min [320-1,520], P=0.005. No significant differences were found between both groups for possible hospital discharge [Hazard Ratio=0.96 (95%CI0.64-1.45)] and hospital discharge [Hazard Ratio=1.20 (95% CI0.79-1.81)]. A mini-invasive early goal-directed hemodynamic therapy based on ECOM can reduce the time to reach extubation but fails to significantly reduce the length of stay in hospital and the rate of major cardiac morbidity. 
540 |a Springer Science+Business Media New York, 2014 
690 7 |a Mini-invasive cardiac output monitoring  |2 nationallicence 
690 7 |a Endotracheal Cardiac Output Monitor  |2 nationallicence 
690 7 |a Goal-directed hemodynamic therapy  |2 nationallicence 
690 7 |a Coronary surgery  |2 nationallicence 
700 1 |a Fellahi  |D Jean-Luc  |u Department of Anesthesiology and Critical Care Medicine, Hôpital Cardiovasculaire et Pneumologique Louis Pradel, Hospices Civils de Lyon, 28 avenue du Doyen Lépine, 69677, Lyon-Bron Cedex, France  |4 aut 
700 1 |a Brossier  |D David  |u Department of Anesthesiology and Critical Care Medicine, CHU de Caen, Avenue de la Côte de Nacre, 14000, Caen, France  |4 aut 
700 1 |a Dechanet  |D Fabien  |u Department of Anesthesiology and Critical Care Medicine, CHU de Caen, Avenue de la Côte de Nacre, 14000, Caen, France  |4 aut 
700 1 |a Fischer  |D Marc-Olivier  |u Department of Anesthesiology and Critical Care Medicine, CHU de Caen, Avenue de la Côte de Nacre, 14000, Caen, France  |4 aut 
700 1 |a Saplacan  |D Vladimir  |u Department of Cardiothoracic Surgery, CHU de Caen, Avenue de la Côte de Nacre, 14000, Caen, France  |4 aut 
700 1 |a Gérard  |D Jean-Louis  |u Department of Anesthesiology and Critical Care Medicine, CHU de Caen, Avenue de la Côte de Nacre, 14000, Caen, France  |4 aut 
700 1 |a Hanouz  |D Jean-Luc  |u Department of Anesthesiology and Critical Care Medicine, CHU de Caen, Avenue de la Côte de Nacre, 14000, Caen, France  |4 aut 
773 0 |t Journal of Clinical Monitoring and Computing  |d Springer Netherlands  |g 29/3(2015-06-01), 351-358  |x 1387-1307  |q 29:3<351  |1 2015  |2 29  |o 10877 
856 4 0 |u https://doi.org/10.1007/s10877-014-9611-5  |q text/html  |z Onlinezugriff via DOI 
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900 7 |a Metadata rights reserved  |b Springer special CC-BY-NC licence  |2 nationallicence 
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950 |B NATIONALLICENCE  |P 700  |E 1-  |a Fellahi  |D Jean-Luc  |u Department of Anesthesiology and Critical Care Medicine, Hôpital Cardiovasculaire et Pneumologique Louis Pradel, Hospices Civils de Lyon, 28 avenue du Doyen Lépine, 69677, Lyon-Bron Cedex, France  |4 aut 
950 |B NATIONALLICENCE  |P 700  |E 1-  |a Brossier  |D David  |u Department of Anesthesiology and Critical Care Medicine, CHU de Caen, Avenue de la Côte de Nacre, 14000, Caen, France  |4 aut 
950 |B NATIONALLICENCE  |P 700  |E 1-  |a Dechanet  |D Fabien  |u Department of Anesthesiology and Critical Care Medicine, CHU de Caen, Avenue de la Côte de Nacre, 14000, Caen, France  |4 aut 
950 |B NATIONALLICENCE  |P 700  |E 1-  |a Fischer  |D Marc-Olivier  |u Department of Anesthesiology and Critical Care Medicine, CHU de Caen, Avenue de la Côte de Nacre, 14000, Caen, France  |4 aut 
950 |B NATIONALLICENCE  |P 700  |E 1-  |a Saplacan  |D Vladimir  |u Department of Cardiothoracic Surgery, CHU de Caen, Avenue de la Côte de Nacre, 14000, Caen, France  |4 aut 
950 |B NATIONALLICENCE  |P 700  |E 1-  |a Gérard  |D Jean-Louis  |u Department of Anesthesiology and Critical Care Medicine, CHU de Caen, Avenue de la Côte de Nacre, 14000, Caen, France  |4 aut 
950 |B NATIONALLICENCE  |P 700  |E 1-  |a Hanouz  |D Jean-Luc  |u Department of Anesthesiology and Critical Care Medicine, CHU de Caen, Avenue de la Côte de Nacre, 14000, Caen, France  |4 aut 
950 |B NATIONALLICENCE  |P 773  |E 0-  |t Journal of Clinical Monitoring and Computing  |d Springer Netherlands  |g 29/3(2015-06-01), 351-358  |x 1387-1307  |q 29:3<351  |1 2015  |2 29  |o 10877