Target-Directed Management Strategy Reduces Complications In High-Risk Subjects Undergoing Cardiac And Major Vascular Surgery

Background and Objective: Early goal-directed therapy (EGDT) has been proved to decrease mortality in severe sepsis and septic shock, which have begun to impact the care of all critically ill subjects. The aim of this study was to evaluate the effect of postoperative target-directed management strategy on the incidence of complications and outcomes in subjects undergoing cardiac and major vascular surgery. Materials and Methods: We performed a retrospective analysis on the adult subjects undergoing cardiac major vascular surgery. The 12-month baseline (1 July 2011 to 30 June 2012) is considered to be the pre-EGDT period, where subjects received usual care after operation. While 12 months from 1 October 2012 to 30 September 2013 is considered the EGDT period, where subjects were treated according to target-directed management strategy. Targets of EGDT protocol were CVP 10-12 mmHg, CI >= 2.4 litre-min(-1)-m(-2), Lactate < 4 mmol litre(-1) and SvO(2) >65 mmHg. Results: There were 101 subjects in the usual care group and 131 in the protocol group. Subjects in the protocol group received more fluid (P< 0.001) and shorter duration of mechanical ventilation (P=0.017). Statistically significant difference was noted with regard to CI (P=0.006), SvO2 (P=0.014), DO2I (P=0.03) and SOFA score (P=0.005) between the protocol and the usual care group. Conclusion: Our study showed that target-directed management strategy significantly reduced the occurrence of postoperative complications in subjects with high risk for adverse outcome after cardiac and major vascular surgery.