A TRIAL OF GOAL-ORIENTED HEMODYNAMIC THERAPY IN CRITICALLY ILL PATIENTS

Background. Hemodynamic therapy to raise the cardiac index and oxygen delivery to supranormal levels may improve outcomes in critically ill patients. We studied whether increasing the cardiac index to a suprano rmal level (cardiac-index group) or increasing mixed venous oxygen sat uration to a normal level (oxygen-saturation group) would decrease mor bidity and mortality among critically ill patients, as compared with a control group in which the target was a normal cardiac index. Methods . A total of 10,726 patients in 56 intensive care units were screened, among whom 762 patients belonging to predefined diagnostic categories with acute physiology scores of 11 or higher were randomly assigned t o the three groups (252 to the control group, 253 to the cardiac-index group, and 257 to the oxygen-saturation group). Results. The hemodyna mic targets were reached by 94.3 percent of the control group, 44.9 pe rcent of the cardiac-index group, and 66.7 percent of the oxygen-satur ation group (P<0.001). Mortality was 48.4, 48.6, and 52.1 percent, res pectively (P=0.638), up to the time of discharge from the intensive ca re unit and 62.3, 61.7, and 63.8 percent (P=0.875) at six months. Amon g patients who survived, the number of dysfunctional organs and the le ngth of the stay in the intensive care unit were similiar in the three groups. No differences in mortality among the three groups were found for any diagnostic category. A subgroup analysis of the patients in w hom hemodynamic targets were reached revealed similar mortality rates: 44.8, 40.4, and 39.0 percent. respectively (P=0.478). Conclusions. He modynamic therapy aimed at achieving supranormal values for the cardia c index or normal values for mixed venous oxygen saturation does not r educe morbidity or mortality among critically ill patients.