A prospective, randomized study of goal-oriented hemodynamic therapy in cardiac surgical patients

Organ dysfunction and multiple organ failure are the main causes of prolong ed hospital stay after cardiac surgery, which increases resource use and he alth care costs, increased levels of oxygen delivery and consumption are as sociated with improved outcome in different groups of postoperative patient s. Cardiac surgical patients are at risk of inadequate perioperative oxygen delivery caused by extracorporeal circulation and limited cardiovascular r eserves. The purpose of our study was to test whether increasing oxygen del ivery immediately after cardiac surgery would shorten hospital and intensiv e care unit (ICU) stay. Four hundred three elective cardiac surgical patien ts were enrolled in the study and randomly assigned to either the control o r the protocol group. Goals of the protocol group were to maintain Svo(2) > 70% and lactate concentration less than or equal to 2.0 mmol/L from admissi on to the ICU and up to 8 h thereafter. Hemodynamics, oxygen transport data , and organ dysfunctions were recorded. The median hospital stay was shorte r in the protocol group (6 vs 7 days, P < 0.05), and patients were discharg ed faster from the hospital than those in the control group (P < 0.05). Dis charge from the ICU was similar between. groups (p = 0.8). Morbidity was le ss frequent at the time of hospital discharge in the protocol group (1.1% v s 6.1%, P < 0.01). Increasing oxygen delivery to achieve normal Svo(2) valu es and lactate concentration during the immediate postoperative period afte r cardiac surgery can shorten the length of hospital stay.