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Critical Care Research and Practice
Volume 2012 (2012), Article ID 821218, 10 pages
http://dx.doi.org/10.1155/2012/821218
Clinical Study

Comparison of Goal-Directed Hemodynamic Optimization Using Pulmonary Artery Catheter and Transpulmonary Thermodilution in Combined Valve Repair: A Randomized Clinical Trial

1Cardiosurgical Intensive Care Unit, City Hospital No. 1, Suvorov Street 1, Arkhangelsk 163001, Russia
2Department of Anesthesiology and Intensive Care Medicine, Northern State Medical University, Troitsky Avenue 51, Arkhangelsk 163000, Russia
3Department of Anesthesiology, University Hospital of North Norway, Tromsø, Norway
4Department of Clinical Medicine (Anesthesiology), Faculty of Medicine, University of Tromsø, 9037 Tromsø, Norway
5Office for International Cooperation, Oslo University Hospital, Kirkeveien 166, 0407 Oslo, Norway

Received 6 February 2012; Accepted 14 February 2012

Academic Editor: Samir Sakka

Copyright © 2012 Andrey I. Lenkin et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Our aim was to compare the effects of goal-directed therapy guided either by pulmonary artery catheter (PAC) or by transpulmonary thermodilution (TTD) combined with monitoring of oxygen transport on perioperative hemodynamics and outcome after complex elective valve surgery. Measurements and Main Results. Forty patients were randomized into two equal groups: a PAC group and a TTD group. In the PAC group, therapy was guided by mean arterial pressure (MAP), cardiac index (CI) and pulmonary artery occlusion pressure (PAOP), whereas in the TTD group we additionally used global end-diastolic volume index (GEDVI), extravascular lung water index (EVLWI), and oxygen delivery index (DO2I). We observed a gradual increase in GEDVI, whereas EVLWI and PAOP decreased by 20–30% postoperatively ( ). The TTD group received 20% more fluid accompanied by increased stroke volume index and DO2I by 15–20% compared to the PAC group ( ). Duration of mechanical ventilation was increased by 5.2 hrs in the PAC group ( ). Conclusions. As compared to the PAC-guided algorithm, goal-directed therapy based on transpulmonary thermodilution and oxygen transport increases the volume of fluid therapy, improves hemodynamics and DO2I, and reduces the duration of respiratory support after complex valve surgery.