Hemodynamic Indices Predictive of a Beneficial Response to Fluid Expansion in Case of Hemodynamic Failure After Cardiac Surgery With Altered Preoperative Ejection Fraction (LVEF≤45%)

Rennes University Hospital50 enrolled

Overview

Low Cardiac Output Syndrome occurs frequently after cardiac surgery, especially when pre-operative LVEF is altered (LVEF≤45%). The correction of hemodynamic failure requires adapted treatments: fluid expansion and/or inotropic or vasoactive drugs. Predictive indices of a response to fluid challenge may allow an earlier hemodynamic optimization, which has not been showed until now when LVEF is altered.

Study Type

INTERVENTIONAL

Allocation

Purpose

OTHER

Masking

NONE

Enrollment

Conditions

Ventricular Dysfunction

Interventions

cardiac surgery for ventricular dysfunctionPROCEDURE

For each included patient during the immediate post operative period, hemodynamic variables will be recorded (continuous arterial pressure, ECG, photoplethysmographic curve, CVP, wedge pressure, respiratory pressure), at rest (proclive 45°), during fluid expansion (physiological saline).

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * patients \>18 years old in the immediate post-operative period after cardiac surgery * ASA 1 - 3 * Pre-operative LVEF≤45% * Sedated with Ramsay score: 6 * Mechanically ventilated with tidal volume at 8ml/kg, PEEP at 0mmHg, I/Eat 0,5 * With hemodynamic failure: SAP≤90mmHg and/or inotropic or vasoactive drug started in the operating room and/or clinical sign of shock and/or CI ≤2,3l/min/m2 * Affiliation to Health Insurance * Consent form signed Exclusion Criteria: * Cardiac arrhythmia: frequent atrial or ventricular extra systoles, atrial fibrillation * Intracardiac shunt * Weight less than 50 kg * History of central nervous system illness * Pulmonary oedema (clinical and/or radiological and/or wedge pressure\>18mmHg) * Right ventricular failure suspected (CVP\> wedge pressure) or diagnosed (trans thoracic and/or transesophageal echocardiography) * Acute kidney injury with oligoanuria * Severe post operative bleeding (chest tubes volume of \>200ml/h for 3 hours or more) * Severe hypoxia (PaO2/FIO2\< 100) * Administrative control (patient under guardianship or curatorship)

Outcomes

Primary Outcomes

Measure of ∆PP, ∆POP, PVI and Cardiac index (CI)

To assess the sensibility and specificity of ∆PP, ∆POP, PVI, after fluid expansion in case of hemodynamic failure in the immediate post-operative period after cardiac surgery, when pre-operative LVEF is altered.

Time frame: 2 hours

Secondary Outcomes

Measure of Systolic, diastolic and mean arterial pressure (SAP, DAP, MAP), Central venous pressure (CVP) and wedge pressure.

Secondary objectives : * Early optimization of hemodynamics after cardiac surgery, * To determine optimal threshold for ∆PP, ∆POP and PVI, * To compare dynamic (∆PP, ∆POP and PVI) with static (central venous pressure: CVP, wedge pressure) indices