[Results of the differentiated use of catecholamines and vasodilators in the early post-bypass phase]

Presented are the results of a procedure to characterize the haemodynamic situation and the required therapy in the early post-bypass period by including haemodynamic parameters (Part, CVP, PLA, TPR, PVR, f, Cl) in a system of seven parameter constellations although directly measured values must be supplemented by clinical data. In this way situations with increased or normal cardiac output and pathological peripheral resistance can be more easily distinguished from situations with reduced cardiac output. The investigations were performed in 300 patients who underwent cardiac surgery in 1985 and 1986. In more than 80% of the patients increased volume alone was not able to end the bypass, and so therapy including catecholamines and/or vasodilatators was instituted. Due to a relatively intensive but specific treatment, a favourable result with a 3% mortality was achieved. The frequency of patients after coronary surgery, valve replacement or correction of congenital heart defects in the seven situations of parameters corresponded to the expected haemodynamic peculiarities. In the group treated with catecholamines only, including 34% of the coronary patients, no increased mortality occurred compared with the total number. In patients in whom the constellation of parameters required a treatment with catecholamines combined with vasodilators, a higher mortality of 8.6% occurred compared with the total result. Here patients are concentrated with whom a good surgical result could not be obtained or the changes of myocardial stimulation were exhausted. Our findings emphasize the importance of the following points for further practice: improvement of invasive monitoring to apply vasodilators more intensively especially in infancy, careful selection of patients for coronary surgery, reduction of negative inotropic drugs preoperatively in high risk patients for improving postoperative stimulation of the myocardium.