Early Goal Directed Therapy in Cardiac Surgery

Objective: To compare postoperative clinical outcome in adult patients undergoing cardiac surgery.

Primary outcome: Postoperative inotropic/vasoactive drugs reqirement.

Secondary outcome: ICU stay.

Methods: Eligible patients will be randomized to 2 groups. Both groups will be managed intraoperatively in the same way, except fluid and inotropic/vasoactive drugs management protocol. EGDT group will be managed according to information derived from FloTrac/EV1000 system, i.e., control stroke volume variation (SVV) 10-13% and give fluid when SVV > 13%, give inotropic to maintain cardiac index (CI) 2.5-4 L/min/m2, and give vasoactive drugs to maintain systemic vascular resistance index (SVRI) of 1,900-2,400 dynes-sec/cm-5/m2 . Control group will be managed using central venous pressure (CVP) protocol, i.e., control CVP 8-12 mmHg and give fluid when CVP < 8 mmHg, give inotropic/vasoactive drugs according to blood pressure and heart rate as well as clinical signs at the discretion of attending anesthesiologists.

Outcome analyses: Postoperative number of inotropic/vasoactive drugs requirement as well as ICU stay of both groups will be compared using unpaired Student-t test or Mann-Whitney U test.

Inclusion criteria

• 18-80 years old
• Patient has ischemic or valvular heart disease
• Scheduled for elective cardiac surgery
• New York Heart Association (NYHA) or American society of Anesthesiology (ASA) classification I-III
• Body mass index (BMI) 18-24 kg/m2
• Provided informed consent before surgery

Exclusion criteria

• Scheduled for emergency or redo surgery
• Difficulty (or contraindication to) placing a central venous catheter
• Inability to cooperate (e.g. mental disorder, disturbance of consciousness, mental retardation)
• Presence of blood-borne infectious disease (e.g. syphilis, acquired immunodeficiency