Randomised controlled trial assessing the impact of a nurse delivered, flow monitored protocol for optimisation of circulatory status after cardiac surgery

Abstract

Objective: To assess whether a nurse led, flow monitored protocol for optimising circulatory status in patients after cardiac surgery reduces complications and shortens stay in intensive care and hospital.

Design: Randomised controlled trial.

Setting: Intensive care unit and cardiothoracic unit of a university teaching hospital.

Participants: 174 patients who underwent cardiac surgery between April 2000 and January 2003.

Interventions: Patients were allocated to conventional haemodynamic management or to an algorithm guided by oesophageal Doppler flowmetry to maintain a stroke index above 35 ml/m2.

Results: 26 control patients had postoperative complications (two deaths) compared with 17 (four deaths) protocol patients (P = 0.08). Duration of hospital stay in the protocol group was significantly reduced from a median of nine (interquartile range 7-12) days to seven (7-10) days (P = 0.02). The mean duration of hospital stay was reduced from 13.9 to 11.4 days, a saving in hospital bed days of 18% (95% confidence interval -12% to 47%). Usage of intensive care beds was reduced by 23% (-8% to 59%).

Conclusion: A nurse delivered protocol for optimising circulatory status in the early postoperative period after cardiac surgery may significantly shorten hospital stay.

Figures

Fig 1

Treatment algorithm to optimise circulatory status in patients after cardiac surgery

Fig 2

Flow of participants through trial

Fig 3

Duration of stay in intensive care and hospital in patients receiving strategy to optimise circulatory status after cardiac surgery (protocol) or conventional management (control). Six hospital stays beyond 50 days not shown