Efficacy of early goal-directed therapy using FloTrac/EV1000 to improve postoperative outcomes in patients undergoing off-pump coronary artery bypass surgery: a randomized controlled trial

Sirirat Tribuddharat, Thepakorn Sathitkarnmanee, Kriangsak Ngamsaengsirisup, Sanpicha Sornpirom, Sirirat Tribuddharat, Thepakorn Sathitkarnmanee, Kriangsak Ngamsaengsirisup, Sanpicha Sornpirom

Abstract

Background: Early goal-directed therapy (EGDT) using FloTrac reduced length of stay (LOS) in intensive care (ICU) and hospital among patients undergoing coronary artery bypass graft (CABG) with a cardiopulmonary bypass. However, this platform in off-pump CABG (OPCAB) has received scant attention, so we evaluated the efficacy of EGDT using FloTrac/EV1000 as a modality for improving postoperative outcomes in patients undergoing OPCAB.

Methods: Forty patients undergoing OPCAB were randomized to the EV1000 or Control group. The Control group received fluid, inotropic, or vasoactive drugs (at the discretion of the attending anesthesiologist) to maintain a mean arterial pressure 65-90 mmHg; central venous pressure 8-12 mmHg; urine output ≥ 0.5 mL kg-1 h-1; SpO2 > 95%; and hematocrit ≥ 30%. The EV1000 group achieved identical targets using information from the FloTrac/EV1000. The goals included stroke volume variation < 13%; cardiac index (CI) of 2.2-4.0 L min-1 m-2; and systemic vascular resistance index of 1500-2500 dynes s-1 cm-5 m-2.

Results: The EV1000 group had a shorter LOS in ICU (mean difference - 1.3 d, 95% CI - 1.8 to - 0.8; P < 0.001). The ventilator time for both groups was comparable (P = 0.316), but the hospital stay for the EV1000 group was shorter (mean difference - 1.4 d, 95% CI - 2.1 to - 0.6; P < 0.001).

Conclusions: EGDT using FloTrac/EV1000 compared to conventional protocol reduces LOS in ICU and hospital among patients undergoing OPCAB. Trial registration This study was retrospectively registered at www.

Clinicaltrials: gov (NCT04292951) on 3 March 2020.

Keywords: Early goal-directed therapy; Hospital; Intensive care unit; Length of stay; Off-pump coronary artery bypass graft.

Conflict of interest statement

The authors have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
COSORT diagram of the study

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