Related Experiment Video
Updated: May 10, 2026

Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Individually optimized hemodynamic therapy reduces complications and length of stay in the intensive care unit: a
Matthias S Goepfert1, Hans Peter Richter, Christine Zu Eulenburg
1* Senior Physician Anesthesiologist, † Anesthesiologist, § Resident, # Professor of Anesthesiology, Director, ** Professor of Anesthesiology, Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. ‡ Statistician, Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf. ‖ Professor of Cardiac Surgery, Director, Department of Cardiovascular Surgery, University Heart Center, University Medical Center Hamburg-Eppendorf.
Background:
The authors hypothesized that goal-directed hemodynamic therapy, based on the combination of functional and volumetric hemodynamic parameters, improves outcome in patients with cardiac surgery. Therefore, a therapy guided by stroke volume variation, individually optimized global end-diastolic volume index, cardiac index, and mean arterial pressure was compared with an algorithm based on mean arterial pressure and central venous pressure.
Methods:
This prospective, controlled, parallel-arm, open-label trial randomized 100 coronary artery bypass grafting and/or aortic valve replacement patients to a study group (SG; n = 50) or a control group (CG; n = 50). In the SG, hemodynamic therapy was guided by stroke volume variation, optimized global end-diastolic volume index, mean arterial pressure, and cardiac index. Optimized global end-diastolic volume index was defined before and after weaning from cardiopulmonary bypass and at intensive care unit (ICU) admission. Mean arterial pressure and central venous pressure served as hemodynamic goals in the CG. Therapy was started immediately after induction of anesthesia and continued until ICU discharge criteria, serving as primary outcome parameter, were fulfilled.
Results:
Intraoperative need for norepinephrine was decreased in the SG with a mean (±SD) of 9.0 ± 7.6 versus 14.9 ± 11.1 µg/kg (P = 0.002). Postoperative complications (SG, 40 vs. CG, 63; P = 0.004), time to reach ICU discharge criteria (SG, 15 ± 6 h; CG, 24 ± 29 h; P < 0.001), and length of ICU stay (SG, 42 ± 19 h; CG, 62 ± 58 h; P = 0.018) were reduced in the SG.
Conclusion:
Early goal-directed hemodynamic therapy based on cardiac index, stroke volume variation, and optimized global end-diastolic volume index reduces complications and length of ICU stay after cardiac surgery.
Related Concept Videos
Heart Failure VI: Adjunct Therapies
Hemodialysis II: Procedure and Complications
Continuous Renal Replacement Therapy
Acute Coronary Syndrome IV: Interprofessional Care
Venous Thrombosis III: Interprofessional Care