Comparison of Postoperative Clinical Outcomes of Patients Followed by Traditional Methods and Transpulmonary Thermodilution Monitoring System in Cardiac Surgery.

Project no. 20397 · Status: Kapanmış · 2019

Summary

Goal-directed therapy with monitoring systems during and after open heart surgery is critical. By traditional methods arterial pressure via the radial artery and central venous pressure via a central catheter inserted in the jugular vein, are measured. By the Swan-Ganz (pulmonary artery) catheter, pressure of the cardiac chambers and cardiac output are measured invasively. PICCO module is less invasive method of hemodynamic monitorization via arterial pulse contour analysis calibrated with transpulmonary thermodilution technique, measuring continuous cardiac index, left heart contractility, systemic vascular resistance, pulse pressure variability, and extravascular lung fluid index. In this study, the aim is to compare the early postoperative outcomes of the patients followed up with the traditional methods and PICCO module. A total of 45 patients (Group P (PICCO): 20, Group K (Conventional): 25) who underwent cardiac surgery at Ege University Cardiovascular Surgery Clinic between 2020-2022 were included in the study. The research was supported by Ege University BAP Coordinator. Femoral artery cannula was inserted in PICCO group, and continuous hemodynamic data were recorded, and the hemodynamics were managed accordingly. The patients in the control group were followed up with the conventional methods. Statistical evaluation was made by recording the preoperative characteristics, intraoperative and postoperative hemodynamic data of the patients and postoperative clinical events. There was no difference in terms of age and gender among the groups. While hypertension, chronic obstructive lung disease and diabetes were more common in Group P, the preoperative left ventricular ejection fraction (44.1% vs. 53.5%, p:0.003) was found to be lower in Group P. Considering the intraoperative data, dopamine use was significantly less at the postoperative 0th and 6th hours in Group P and dobutamine use was higher. Erythrocyte suspension was transfused more frequently in Group K at the postoperative 0th hour. All the other postoperative complications were found to be statistically similar among the groups. Considering the hemodynamic data of patients in PICCO group there was a 42% increase in cardiac index, a 33% decrease in systemic resistance, and a 33% increase in global ejection fraction. Hemodynamic monitoring by PICCO module provides detailed data for goal-directed therapy and the decision model for management. By its use, inotropic management and transfusion applications in the early postoperative period is improved, but its effects on complications and mortality is not shown.

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