Individually optimized hemodynamic therapy reduces complications and length of stay in the intensive care unit: a prospective, randomized controlled trial

Anesthesiology. 2013 Oct;119(4):824-36. doi: 10.1097/ALN.0b013e31829bd770.


Background: The authors hypothesized that goal-directed hemodynamic therapy, based on the combination of functional and volumetric hemodynamic parameters, improves outcome in patients with cardiac surgery. Therefore, a therapy guided by stroke volume variation, individually optimized global end-diastolic volume index, cardiac index, and mean arterial pressure was compared with an algorithm based on mean arterial pressure and central venous pressure.

Methods: This prospective, controlled, parallel-arm, open-label trial randomized 100 coronary artery bypass grafting and/or aortic valve replacement patients to a study group (SG; n = 50) or a control group (CG; n = 50). In the SG, hemodynamic therapy was guided by stroke volume variation, optimized global end-diastolic volume index, mean arterial pressure, and cardiac index. Optimized global end-diastolic volume index was defined before and after weaning from cardiopulmonary bypass and at intensive care unit (ICU) admission. Mean arterial pressure and central venous pressure served as hemodynamic goals in the CG. Therapy was started immediately after induction of anesthesia and continued until ICU discharge criteria, serving as primary outcome parameter, were fulfilled.

Results: Intraoperative need for norepinephrine was decreased in the SG with a mean (±SD) of 9.0 ± 7.6 versus 14.9 ± 11.1 µg/kg (P = 0.002). Postoperative complications (SG, 40 vs. CG, 63; P = 0.004), time to reach ICU discharge criteria (SG, 15 ± 6 h; CG, 24 ± 29 h; P < 0.001), and length of ICU stay (SG, 42 ± 19 h; CG, 62 ± 58 h; P = 0.018) were reduced in the SG.

Conclusion: Early goal-directed hemodynamic therapy based on cardiac index, stroke volume variation, and optimized global end-diastolic volume index reduces complications and length of ICU stay after cardiac surgery.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenergic alpha-Agonists / therapeutic use
  • Aged
  • Aortic Valve / surgery
  • Arterial Pressure / drug effects
  • Arterial Pressure / physiology
  • Cardiac Surgical Procedures / methods*
  • Central Venous Pressure / drug effects
  • Central Venous Pressure / physiology
  • Coronary Artery Bypass / methods
  • Diastole / drug effects
  • Diastole / physiology
  • Epinephrine / therapeutic use
  • Female
  • Hemodynamics / drug effects
  • Hemodynamics / physiology*
  • Humans
  • Hydroxyethyl Starch Derivatives / therapeutic use
  • Intensive Care Units / statistics & numerical data*
  • Isotonic Solutions / therapeutic use
  • Length of Stay / statistics & numerical data*
  • Male
  • Plasma Substitutes / therapeutic use
  • Postoperative Complications / prevention & control*
  • Prospective Studies
  • Ringer's Solution
  • Stroke Volume / drug effects
  • Stroke Volume / physiology


  • Adrenergic alpha-Agonists
  • Hydroxyethyl Starch Derivatives
  • Isotonic Solutions
  • Plasma Substitutes
  • Ringer's Solution
  • Epinephrine