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


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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: 510 min [360-1,110] versus 570 min [320-1,520], P = 0.005. No significant differences were found between both groups for possible hospital discharge [Hazard Ratio = 0.96 (95 % CI 0.64-1.45)] and hospital discharge [Hazard Ratio = 1.20 (95 % CI 0.79-1.81)]. 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.

Resumo Limpo

object compar impact earli goaldirect hemodynam therapi base cardiac output monitor endotrach cardiac output monitor ecom standard care postop outcom follow coronari surgeri prospect control parallelarm trial random elect primari coronari arteri bypass graft patient studi group ecom n control group control n ecom group hemodynam therapi guid respiratori stroke volum variat cardiac index given ecom system standard care use control goaldirect therapi start immedi induct anesthesia continu arriv intens care unit icu primari endpoint time patient fulfil discharg criteria hospit possibl hospit discharg secondari endpoint hospit discharg time reach extub length stay icu number major advers cardiac event inhospit mortal patient ecom group receiv often fluid load dobutamin time reach extub reduc ecom group min versus min p signific differ found group possibl hospit discharg hazard ratio ci hospit discharg hazard ratio ci miniinvas earli goaldirect hemodynam therapi base ecom can reduc time reach extub fail signific reduc length stay hospit rate major cardiac morbid

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