Postoperative Heart Insufficiency
Conditions
Keywords
transesophageal echocardiography, tee, toe, cardiac surgery
Brief summary
Compromised tissue oxygenation during surgery may negatively influence patient outcome. Primary cause of insufficient tissue oxygenation is reduced cardiac output due to hypovolemia and/or reduced cardiac contractility. In cardiac surgery patients especially, postoperative pericardia effusion and/or tamponade may further compromise cardiac function. Today, hemodynamically instable patients are often monitored by means of pulmonal artery catheters or transpulmonary thermodilution. However, these methods only allow quantification of functional limitations. Underlying causes may be investigated by relatively recent technology through hemodynamically focussed transesophageal echocardiography (ClariTEE(R) ImaCor) that also provide the possibility of continuous monitoring. It has been reported that a training program consisting of six hours may enable physicians who are unexperienced in the field of echocardiography to apply this new method. Up to now, there is no evidence whether this methods is associated with improved postoperative outcome. Therefore we hypothesize that continuous hemodynamically focussed transesophageal echocardiography positively influences patient outcome (primary hypothesis). Furthermore, its application may decrease hospital expenses (secondary hypothesis).
Interventions
None listed
Sponsors
Charite University, Berlin, Germany
Study design
Observational model
CASE_CONTROL
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* elective, cardiac surgery * hemodynamic instability or placement of hTEE/PICCO (Pulse Contour Continuous Cardiac Output) /PAC (Pulmonary Arterial Catheter) within 12 hours of ICU admission
Exclusion criteria
* pregnant/breastfeeding women
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Cumulative dosage of catecholamine application | three days beginning upon placement of device |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| fluid balance | day 1, 2 and 3, beginning upon placement of device (or icu admission in control patients, respectively) | — |
| degree and duration of lactate acidosis | degree and duration of other vasoactive substances three days beginning upon placement of device (or icu admission in control patients, respectively) | maximum lactate level, date/time of maximum lactate level, first date/time when lactate \<20 |
| duration of postoperative ventilation | first postoperative day until extubation (2 days on average) | — |
| incidence of renal failure | three days beginning upon placement of device (or icu admission in control patients, respectively) | analysis of creatinine plasma level |
| degree and duration of other vasoactive substances | degree and duration of other vasoactive substances three days beginning upon placement of device (or icu admission in control patients, respectively) | i.e. epinephrine, levosimendan, dopamine, nitroglycerine, nitroprusside |
| length of hospital stay | participants will be followed for the duration of hospital stay, an expected average of 3 weeks | — |
| in-hospital mortality | participants will be followed for the duration of hospital stay, an expected average of 3 weeks | — |
| cost of hospital stay | participants will be followed for the duration of hospital stay, an expected average of 3 weeks | — |
| incidence of hemodialysis | three days beginning upon placement of device (or icu admission in control patients, respectively) | — |
Countries
Germany
Outcome results
None listed