What’s the best assessment of preload after cardiac surgery?

https://doi.org/10.4081/monaldi.2005.606

Authors

  • Maria Rosario Piccirillo U.O. Cardioanestesia e Terapia Intensiva Cardiochirurgica, Università Federico II di Napoli, Italy.
  • Armando Natale U.O. Cardioanestesia e Terapia Intensiva Cardiochirurgica, Università Federico II di Napoli, Italy.
  • Giovanni Trosino Cattedra di Anestesia e Rianimazione Università Federico II di Napoli, Italy.
  • Marianna Sebastopoli Cattedra di Anestesia e Rianimazione Università Federico II di Napoli, Italy.
  • Giovanni Vivona Cattedra di Anestesia e Rianimazione Università Federico II di Napoli, Italy.
  • Giovanni De Martino Cattedra di Anestesia e Rianimazione Università Federico II di Napoli, Italy.
  • Gennaro Ismeno | gennaroismeno@yahoo.com Dipartimento Chirurgia Cardiaca e Vascolare Azienda Ospedaliera “San Sebastiano” Caserta, Italy.
  • Luigi Piazza Dipartimento Chirurgia Cardiaca e Vascolare Azienda Ospedaliera “San Sebastiano” Caserta, Italy.
  • Luigi Belloni U.O. Cardioanestesia e Terapia Intensiva Cardiochirurgica, Università Federico II di Napoli, Italy.

Abstract

Objective: The assessment of the role of transesophageal echocardiography and invasive tests with pulmonary modified catheter to monitor the preload indexes in patients in intensive- care-unit after cardiac coronary surgery. Materials and Methods: Between January and December 2004 24 patients (14 male, 10 female) with coronary artery disease were prospectively enrolled for preload assessment during off-pump myocardial revascularization. Pulmonary Capillary Wedge Pressure (PCWP), Left Ventricular End Diastolic Indexed Area (LVEDAI), Δ Aortic Velocity (ΔVAo), Right Ventricular End Diastolic Volume (RVEDVI) as preload indexes were evaluated. Transesophageal echocardiography and pulmonary modified catheter monitoring were performed during the preoperative period at T1 and after fluid infusion (T2). Patients were considered Responders (R) or No Responders (NR) if the Stroke Volume Index increase at T2 was >20% with respect to T1. Results: Mean T1 PCWP was similar in both groups (12.8±2.2 in R vs. 11.4±3 mmHg in NR; p=NS) and mean increase of PCWP at T2 was similar in both groups (1.5±0.3% in R vs. 1.2±3% in NR; p=NS). Mean T1 RVEDVI was similar in both groups (97.33±34 in R vs. 101±21 ml/m2 in NR; p=NS); T2 RVEDVI was similar in R and NR Groups (122.11±49 vs. 138.54±30 ml/m2; p=NS); mean T1 and T2 LVEDAI was similar in R and NR (11.2±3.5 vs. 10.2±2.3 at T1 and 14.04±3.35 vs. 14.67±2.1 cm2/m2 at T2 respectively; p=NS). Higher mean value of T1 ΔVAo (20±7% in R vs. 10±2% in NR; p=0.006) were recorded while similar mean value of T2 ΔVAo were observed (11±3% in R vs. 5±2% in NR; p=0.743). Correlation index between T1 and T2 ΔVAo (R=0.82) in R was significant (p=0.0002), while correlation index between T1 and T2 ΔVAo (R=0.11) in NR was not significant. Conclusions: Our study showed in patients soon after coronary cardiac surgery ΔVAo is the only predictor of “fluid responsiveness†and of ventricular compliance.

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Published
2005-03-30
Info
Issue
Section
Original Articles
Keywords:
off-pump coronary artery by-pass graft, transesophageal echocardiography, pulmonary catheter
Statistics
  • Abstract views: 344

  • PDF: 274
How to Cite
Piccirillo, Maria Rosario, Armando Natale, Giovanni Trosino, Marianna Sebastopoli, Giovanni Vivona, Giovanni De Martino, Gennaro Ismeno, Luigi Piazza, and Luigi Belloni. 2005. “What’s the Best Assessment of Preload After Cardiac Surgery?”. Monaldi Archives for Chest Disease 64 (1). https://doi.org/10.4081/monaldi.2005.606.

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