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Different Modes of Monitoring and Correction of Cardiac Function During Operations Under Extracorporeal Circulation

https://doi.org/10.15360/1813-9779-2007-1-48-51

Abstract

Objective: to comparatively evaluate the efficiency of intensive care measures chosen on the basis of traditional monitoring of central hemodynamics (CH) or on that of the data of transesophageal echocardiography (TE echoCG).

Materials and methods: 50 patients were examined at coronary bypass surgery under extracorporeal circulation. Under a prospective comparative analysis were two algorithms of treatment policy: maintenance of cardiac index, by using the maximum volemic load, or that of left ventricular systolic function under guidance of transesophageal echocardiography.

Results: Significantly (p<0.05) larger doses of dopamine and/or dobutamine were required to maintain adequate left ventricular systolic function. However, this treatment policy showed much better (p<0.05) circulatory parameters in the postperfusion period. At the same time the duration of postoperative inotropic therapy in these patients proved to be significantly (p<0.05) less.

Conclusion. The treatment policy based on the maintenance of left ventricular systolic function under guidance of TE echoCG leads to the shortest circulatory stabilization during myocardial revascularization. The application of a volemic load and the expectant use of inotropic drugs result in a longer restoration of operated heart function.

 

About the Authors

L. A. Krichevsky
Research Institute of Transplantology and Artificial Organs, Russian Ministry of Health


I. A. Kozlov
Research Institute of Transplantology and Artificial Organs, Russian Ministry of Health


References

1. Swan J. H. C., Ganz W., Forrester J. et al. Catheterization of the heart in man with use of a flow-directed balloon-tipped catheter. N. Engl. J. Med. 1970; 283: 447—453.

2. Tuman K. J., McCarthy R. J., Spiess B. D. et al. Effect of pulmonary artery catheterization on outcome in patients undergoing coronary artery surgery. Anesthesiology 1989; 70: 199—204.

3. Gordon R., Cerra F., Demling R., et al. Pulmonary artery catheterization and clinical outcomes. JAMA 2000; 283: 2568—2572.

4. Hall J. B. Searching for evidence to support pulmonary artery catheter use in critically ill patients. JAMA 2005; 294: 1693—1697.

5. Robin E. D. The cult of Swan-Ganz catheter. Ann. Intern. Med. 1985; 103: 445—452.

6. Shah M. R., Hasselblad V., Stevenson L. V. et al. Impact of the pulmonary artery catheter in critically ill patients: Meta analysis of randomized clinical trials. JAMA 2005; 294: 1664—1671.

7. The ESCAPE investigators and ESCAPE study coordinators. Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness. JAMA 2005; 294: 1625—1633.

8. Wagner D. L. Hemodynamic Monitoring. In: Risk and Outcome in Anesthesia, 2nd edition, ed. by Brown D. L., J. B. Lippincott Company, Philadelphia 1992: 283—313.

9. Davies L. K., Davis R. F. Cardiothoracic anesthesia. In: Risk and Outcome in Anesthesia, 2nd edition, ed. by Brown D. L., J. B. Lippincott Company, Philadelphia 1992; 258—282.

10. Ibert T. J., Fisher E. P., Leibowitz A. B. et al. The multicenter pulmonary artery catheter study: The impact of education and experience. Anesth. Analg. 1990; 70: S167.

11. Pinsky M. R. Hemodynamic monitoring over the past 10 years. Crit. Care. 2006; 10: 117—124.

12. Bolling S. F., Diskstein M. L., Levy J. H. et al. Management strategies for high-risk cardiac surgery: improving outcomes in patients with heart failure. The Heart Surgery Forum 2000; 3: 337—349.

13. Kolev N., Brase R., Swanevelder J. et al. The influence of transoesofageal echocardiography on intra-operative decision making. A European multicentre study. European Perioperative TOE Research Group. Anaesthesia 1998; 53: 767—773.

14. Козлов И. А., Кричевский Л. А., Дзыбинская Е. В. Чреспищеводная эхокардиография, как метод анестезиологического мониторинга, при кардиохирургических операциях и трансплантации сердца. Вестник трансплантологии и искусственных органов 2006, № 4, стр. 47—50.

15. Бокерия Л. А., Бузиашвили Ю. И. Чреспищеводная эхокардиография в коронарной хирургии. М: Издательство НЦССХ им. А. Н. Бакулева РАМН 1999, с. 115.

16. Shoemaker W. C., Bayard D. S., Wo C. C. et al. A stochastic control program to predict outcome and to support therapeutic decisions: a preliminary report. J. Clin. Monit. Comput. 2005; 19: 223—230.


Review

For citations:


Krichevsky L.A., Kozlov I.A. Different Modes of Monitoring and Correction of Cardiac Function During Operations Under Extracorporeal Circulation. General Reanimatology. 2007;3(1):48-51. (In Russ.) https://doi.org/10.15360/1813-9779-2007-1-48-51

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ISSN 1813-9779 (Print)
ISSN 2411-7110 (Online)