Cardiac surgery patients present considerable variation in pre-operative hemodynamic variables

Area of Science:

• Cardiology
• Anesthesiology
• Critical Care Medicine

Background:

• Hemodynamic control is crucial in cardiac surgery for optimizing patient outcomes.
• Pre-operative hemodynamic values are often unknown, and treatment goals lack evidence-based consensus.
• This can lead to suboptimal patient management, including under- or over-treatment.

Purpose of the Study:

• To evaluate commonly used hemodynamic variables for post-operative guidance in cardiac surgery.
• To establish pre-operative hemodynamic reference data for cardiac surgery patients.

Main Methods:

• Invasive hemodynamic monitoring was conducted on ten patients undergoing elective cardiac surgery.
• Data were collected electronically and automatically the night before surgery.

Main Results:

• Significant inter-patient differences and intra-patient variations were observed in hemodynamic parameters.
• Cardiac index (CI) showed the greatest variation (1.9-5.3 l/min/m²), with four patients experiencing CI <2.4 l/min/m².
• Eight patients had SpO2 <92%, and six had SvO2 <70% for significant portions of the observation period.

Conclusions:

• This study provides unique pre-operative hemodynamic reference data for cardiac surgery patients.
• Unexpectedly high intra-patient variability highlights challenges in using current hemodynamic parameters for treatment guidance.
• Goal-oriented therapy based on accepted values may result in over-treatment for some patients.