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Master Thesis

Enquête sur le monitorage hémodynamique et l’utilisation des agents inotropes positifs et vasoactifs en chirurgie cardiaque

Abstract : Introduction: in the past years, new devices for hemodynamic monitoring and new inotropic/vasoactives drugs modified intraoperative hemodynamic optimisation in cardiac surgery. This study aimed to assess these changes. Material and methods: we conducted a prospective multicentric study. Results: 37 centres included 3100 patients. Advanced hemodynamic monitoring was used in 1656 (53,4%) patients, mainly by transoesophageal echocardiography (TOE) (37%), S(c)V02 measurement (22%) and pulmonary artery catheter (PAC) (12%). The monitored patients had higher mortality and complications rate (respectively 5,3% vs 2,3% p<.001 and 49,6% vs 33,5% p<.001), higher Euroscore II, lower LVEF, more emergency and combined surgery, more anaemia and kidney failure. Use of new devices was low (oesophageal Doppler, impedencemetry, and transpulmonary thermodilution less than 1%). New drugs were rarely used (levosimendan 0,3%, milrinone 0,7%), norepinephrine (50%) and dobutamine (13%) were the first line drugs. After standardisation on Euroscore II, monitored patients did not presented a lower complication rate. Discussion: our study highlight some changes: TOE is the first used device, followed by PAC. Norepinephrine is the first line drug. Our study did not find any outcome improvement with the use of advanced hemodynamic monitoring during cardiac surgery.
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https://dumas.ccsd.cnrs.fr/dumas-01860340
Contributor : Ufr Santé Unicaen <>
Submitted on : Thursday, August 23, 2018 - 11:42:17 AM
Last modification on : Tuesday, April 14, 2020 - 12:23:19 PM

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Raphaël d'Orlando. Enquête sur le monitorage hémodynamique et l’utilisation des agents inotropes positifs et vasoactifs en chirurgie cardiaque. Médecine humaine et pathologie. 2018. ⟨dumas-01860340⟩

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