Cardiac surgery patients present considerable variation in pre-operative hemodynamic variables

Authors

  • E. SLOTH,

    1. Departments of 1Anesthesia & Intensive Care Medicine and 2Cardiothoracic Surgery, Aarhus University Hospital, Skejby, DK-8200 Aarhus N, Denmark
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  • 1 C. LINDSKOV,

    1. Departments of 1Anesthesia & Intensive Care Medicine and 2Cardiothoracic Surgery, Aarhus University Hospital, Skejby, DK-8200 Aarhus N, Denmark
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  • 1 A.-G. LORENTZEN,

    1. Departments of 1Anesthesia & Intensive Care Medicine and 2Cardiothoracic Surgery, Aarhus University Hospital, Skejby, DK-8200 Aarhus N, Denmark
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  • 1 M. NYGAARD,

    1. Departments of 1Anesthesia & Intensive Care Medicine and 2Cardiothoracic Surgery, Aarhus University Hospital, Skejby, DK-8200 Aarhus N, Denmark
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  • 1 H. H. KURE,

    1. Departments of 1Anesthesia & Intensive Care Medicine and 2Cardiothoracic Surgery, Aarhus University Hospital, Skejby, DK-8200 Aarhus N, Denmark
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  • and 2 C.-J. JAKOBSEN 1

    1. Departments of 1Anesthesia & Intensive Care Medicine and 2Cardiothoracic Surgery, Aarhus University Hospital, Skejby, DK-8200 Aarhus N, Denmark
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Address:
Carl-Johan Jakobsen
Department of Anesthesia & Intensive Care Medicine
Aarhus University Hospital, Skejby
DK-8200 Aarhus N
Denmark
e-mail: cjj@dadlnet.dk

Abstract

Background: It is essential to control hemodynamics in cardiac surgery. Patients are often monitored extensively in order to optimize hemodynamic performance. However, pre-operative values are normally unknown. Furthermore, hemodynamic goals may seem arbitrary and the lack of an evidence-based consensus may lead to both under- and over-treatment. The aim of this study was to evaluate the variables most commonly used for hemodynamic guidance in the post-operative period.

Methods: Ten patients scheduled for elective cardiac surgery were followed with invasive hemodynamic monitoring the night before surgery. All data were recorded automatically and electronically.

Results: We found considerable inter-patient differences and intra-patient variation. The greatest intra-patient variation was found in the cardiac index (CI), ranging from 1.9 to 5.3 l/min/m2. Four patients had periodic CI <2.4 l/min/m2. Eight patients showed SpO2 values ≤92, four of them in more than 15% of the observations. Six patients had an SvO2 <70% in more than 40% of the observations and two an SvO2<64% in more than 20% of the observations.

Conclusions: This study is unique because hemodynamic reference data in cardiac surgery patients have not been published previously. The intra-patient variations were unexpectedly high in most hemodynamic variables and demonstrate the difficulties of using hemodynamic parameters as a guidance for treatment and indicate that goal-oriented therapy using currently accepted values may result in over-treatment in some patients.

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