Protocolized resuscitation with esophageal Doppler monitoring may improve outcome in post-cardiac surgery patients 英文参考文献.docVIP

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Protocolized resuscitation with esophageal Doppler monitoring may improve outcome in post-cardiac surgery patients 英文参考文献.doc

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Protocolized resuscitation with esophageal Doppler monitoring may improve outcome in post-cardiac surgery patients 英文参考文献

Available online at /content/9/4/E7 Evidence-Based Medicine Journal Club EBM Journal Club Section Editor: Eric B. Milbrandt, MD, MPH Journal club critique Protocolized resuscitation with esophageal Doppler monitoring may improve outcome in post-cardiac surgery patients Mehrnaz Hadian1 and Derek C. Angus2 1 2 Clinical Fellow, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA Professor, CRISMA Laboratory, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA Published online: 28 April 2005 Critical Care 9: E7 (DOI 10.1186/cc3716) This article is online at /content/9/4/E7 ? 2005 BioMed Central Ltd Expanded Abstract Citation until the stroke volume index no longer increased by 10% 2 and was 35 ml/m . Thereafter, the algorithm provided additional instructions for vasoactive agents based on blood pressure and stroke volume index (refer to figure 1 in original article). The algorithm was run until 4 hours post- probe insertion or until extubation if 4h. In the control group, probe readings were obtained by a study nurse on insertion and at four hours or at extubation if 4h, but the clinical team was blinded to these readings. The control group received standard postoperative care, using markers of tissue perfusion such as urine output and arterial base deficit, and monitoring cardiac output if clinically indicated. McKendry M, McGloin H, Saberi D, Caudwell L, Brady AR, Singer M: Randomised controlled trial assessing the impact of a nurse delivered, flow monitored protocol for optimisation of circulatory status after cardiac surgery. BMJ 2004, 329:258-261 [1]. Hypothesis Four hours of nurse-led, flow-monitored protocolized resuscitation reduces complications and shortens stay in intensive care and hospital for post-operative cardiac surgery subjects compared to usual care. Outcomes: The primary outcomes were length of stay in intensive care and