gms | German Medical Science

129. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

24.04. - 27.04.2012, Berlin

Hemodynamic Optimization using FloTrac Pulse Contour Analysis in TAVI patients: Early results of al valuable tool in postoperative fluid management

Meeting Abstract

  • Georg Langebartels - Uniklinik Köln / Herzzentrum Köln, Klinik für Herz- und Thoraxchirurgie, Köln
  • Thomas Kuhl - Uniklinik Köln / Herzzentrum Köln, Klinik für Herz- und Thoraxchirurgie, Köln
  • Stefanie Wendt - Uniklinik Köln / Herzzentrum Köln, Klinik für Herz- und Thoraxchirurgie, Köln
  • Irene Fuß - Uniklinik Köln / Herzzentrum Köln, Klinik für Herz- und Thoraxchirurgie, Köln
  • Parwis Rahmanian - Uniklinik Köln / Herzzentrum Köln, Klinik für Herz- und Thoraxchirurgie, Köln
  • Jens Wippermann - Uniklinik Köln / Herzzentrum Köln, Klinik für Herz- und Thoraxchirurgie, Köln
  • Thorsten Wahlers - Uniklinik Köln / Herzzentrum Köln, Klinik für Herz- und Thoraxchirurgie, Köln

Deutsche Gesellschaft für Chirurgie. 129. Kongress der Deutschen Gesellschaft für Chirurgie. Berlin, 24.-27.04.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. Doc12dgch178

DOI: 10.3205/12dgch178, URN: urn:nbn:de:0183-12dgch1789

Published: April 23, 2012

© 2012 Langebartels et al.
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Outline

Text

Introduction: Fluid challenge and fluid response are markable points in hemodynamic optimization on the ICU. Pulse contour analysis is known as a important tool in extended hemodynamic monitoring. Measurement of continuous cardiac output and stroke volume variation as dynamic hemodynamic parameters may be helpful in perioperative management in a high risk group of TAVI patients. Aim of the study was to analyze if extended hemodynamic measurement using the Edwards FloTrac® Sensor with pulse contour analysis improves postoperative outcome in these group of high risk surgical patients

Materials and methods: TAVI procedure was performed in 50 patients. 25 patients received baseline monitoring as recommended in the S3 treatment guideline for patients after cardiac surgery (Group 1) whereas 25 patients additionally received extended hemodynamic measurement using the Edwards FloTrac® Sensor for pulse contour analysis (Group 2). Measurement of cardiac index (CI), stroke volume variation (SVV) and systemic vascular resistance (SVR) were sampled and implicated in the ICU-treatment-strategy for postoperative fluid management and inotropic support. The groups were analyzed for length of stay on ICU and hospital (LOS-ICU, LOS-HOSP), time of ventilation (TOV), acute renal failure (ARF) and Mortality.

Results: The demographic data were similar in both groups concerning risk factors and age (81.5; 66% female). No significant differences were found concerning LOS-ICU, LOS-HOSP, Mortality and TOV but with a remarkable trend favouring Group 2 to shorter LOS-ICU (5.6 ± 4 vs. 4.5 ± 4), LOS-HOSP (13.2 ± 9 vs. 11.6 ± 3). Group 2 showed significant lower postoperative levels of serum creatinine (Group 1: 2.4mg/dl vs. Group 2: 1.5mg/dl) and lower postoperative increase in serum creatinine (Group 1 Δ C: 1.1mg/dl; Group Δ C: 0.37mg/dl).

Conclusion: Hemodynamic optimization guided by pulse contour analysis improves the postoperative management on the ICU. We showed reduced LOS in hospital and ICU. Optimization of fluid management showed a protective effect on kidney function and might improve outcome in high risk TAVI patients