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Dobutamine-sparing versus dobutamine-to-all strategy in cardiac surgery: a randomized noninferiority trial

BACKGROUND: The detrimental effects of inotropes are well-known, and in many fields they are only used within a goal-directed therapy approach. Nevertheless, standard management in many centers includes administering inotropes to all patients undergoing cardiac surgery to prevent low cardiac output...

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Autores principales: Franco, Rafael Alves, de Almeida, Juliano Pinheiro, Landoni, Giovanni, Scheeren, Thomas W. L., Galas, Filomena Regina Barbosa Gomes, Fukushima, Julia Tizue, Zefferino, Suely, Nardelli, Pasquale, de Albuquerque Piccioni, Marilde, Arita, Elisandra Cristina Trevisan Calvo, Park, Clarice Hyesuk Lee, Cunha, Ligia Cristina Camara, de Oliveira, Gisele Queiroz, Costa, Isabela Bispo Santos da Silva, Kalil Filho, Roberto, Jatene, Fabio Biscegli, Hajjar, Ludhmila Abrahão
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7838231/
https://www.ncbi.nlm.nih.gov/pubmed/33496877
http://dx.doi.org/10.1186/s13613-021-00808-6
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author Franco, Rafael Alves
de Almeida, Juliano Pinheiro
Landoni, Giovanni
Scheeren, Thomas W. L.
Galas, Filomena Regina Barbosa Gomes
Fukushima, Julia Tizue
Zefferino, Suely
Nardelli, Pasquale
de Albuquerque Piccioni, Marilde
Arita, Elisandra Cristina Trevisan Calvo
Park, Clarice Hyesuk Lee
Cunha, Ligia Cristina Camara
de Oliveira, Gisele Queiroz
Costa, Isabela Bispo Santos da Silva
Kalil Filho, Roberto
Jatene, Fabio Biscegli
Hajjar, Ludhmila Abrahão
author_facet Franco, Rafael Alves
de Almeida, Juliano Pinheiro
Landoni, Giovanni
Scheeren, Thomas W. L.
Galas, Filomena Regina Barbosa Gomes
Fukushima, Julia Tizue
Zefferino, Suely
Nardelli, Pasquale
de Albuquerque Piccioni, Marilde
Arita, Elisandra Cristina Trevisan Calvo
Park, Clarice Hyesuk Lee
Cunha, Ligia Cristina Camara
de Oliveira, Gisele Queiroz
Costa, Isabela Bispo Santos da Silva
Kalil Filho, Roberto
Jatene, Fabio Biscegli
Hajjar, Ludhmila Abrahão
author_sort Franco, Rafael Alves
collection PubMed
description BACKGROUND: The detrimental effects of inotropes are well-known, and in many fields they are only used within a goal-directed therapy approach. Nevertheless, standard management in many centers includes administering inotropes to all patients undergoing cardiac surgery to prevent low cardiac output syndrome and its implications. Randomized evidence in favor of a patient-tailored, inotrope-sparing approach is still lacking. We designed a randomized controlled noninferiority trial in patients undergoing cardiac surgery with normal ejection fraction to assess whether an dobutamine-sparing strategy (in which the use of dobutamine was guided by hemodynamic evidence of low cardiac output associated with signs of inadequate tissue perfusion) was noninferior to an inotrope-to-all strategy (in which all patients received dobutamine). RESULTS: A total of 160 patients were randomized to the dobutamine-sparing strategy (80 patients) or to the dobutamine-to-all approach (80 patients). The primary composite endpoint of 30-day mortality or occurrence of major cardiovascular complications (arrhythmias, acute myocardial infarction, low cardiac output syndrome and stroke or transient ischemic attack) occurred in 25/80 (31%) patients of the dobutamine-sparing group (p = 0.74) and 27/80 (34%) of the dobutamine-to-all group. There were no significant differences between groups regarding the incidence of acute kidney injury, prolonged mechanical ventilation, intensive care unit or hospital length of stay. DISCUSSION: Although it is common practice in many centers to administer inotropes to all patients undergoing cardiac surgery, a dobutamine-sparing strategy did not result in an increase of mortality or occurrence of major cardiovascular events when compared to a dobutamine-to-all strategy. Further research is needed to assess if reducing the administration of inotropes can improve outcomes in cardiac surgery. Trial registration ClinicalTrials.gov, NCT02361801. Registered Feb 2nd, 2015. https://clinicaltrials.gov/ct2/show/NCT02361801
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spelling pubmed-78382312021-02-04 Dobutamine-sparing versus dobutamine-to-all strategy in cardiac surgery: a randomized noninferiority trial Franco, Rafael Alves de Almeida, Juliano Pinheiro Landoni, Giovanni Scheeren, Thomas W. L. Galas, Filomena Regina Barbosa Gomes Fukushima, Julia Tizue Zefferino, Suely Nardelli, Pasquale de Albuquerque Piccioni, Marilde Arita, Elisandra Cristina Trevisan Calvo Park, Clarice Hyesuk Lee Cunha, Ligia Cristina Camara de Oliveira, Gisele Queiroz Costa, Isabela Bispo Santos da Silva Kalil Filho, Roberto Jatene, Fabio Biscegli Hajjar, Ludhmila Abrahão Ann Intensive Care Research BACKGROUND: The detrimental effects of inotropes are well-known, and in many fields they are only used within a goal-directed therapy approach. Nevertheless, standard management in many centers includes administering inotropes to all patients undergoing cardiac surgery to prevent low cardiac output syndrome and its implications. Randomized evidence in favor of a patient-tailored, inotrope-sparing approach is still lacking. We designed a randomized controlled noninferiority trial in patients undergoing cardiac surgery with normal ejection fraction to assess whether an dobutamine-sparing strategy (in which the use of dobutamine was guided by hemodynamic evidence of low cardiac output associated with signs of inadequate tissue perfusion) was noninferior to an inotrope-to-all strategy (in which all patients received dobutamine). RESULTS: A total of 160 patients were randomized to the dobutamine-sparing strategy (80 patients) or to the dobutamine-to-all approach (80 patients). The primary composite endpoint of 30-day mortality or occurrence of major cardiovascular complications (arrhythmias, acute myocardial infarction, low cardiac output syndrome and stroke or transient ischemic attack) occurred in 25/80 (31%) patients of the dobutamine-sparing group (p = 0.74) and 27/80 (34%) of the dobutamine-to-all group. There were no significant differences between groups regarding the incidence of acute kidney injury, prolonged mechanical ventilation, intensive care unit or hospital length of stay. DISCUSSION: Although it is common practice in many centers to administer inotropes to all patients undergoing cardiac surgery, a dobutamine-sparing strategy did not result in an increase of mortality or occurrence of major cardiovascular events when compared to a dobutamine-to-all strategy. Further research is needed to assess if reducing the administration of inotropes can improve outcomes in cardiac surgery. Trial registration ClinicalTrials.gov, NCT02361801. Registered Feb 2nd, 2015. https://clinicaltrials.gov/ct2/show/NCT02361801 Springer International Publishing 2021-01-26 /pmc/articles/PMC7838231/ /pubmed/33496877 http://dx.doi.org/10.1186/s13613-021-00808-6 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Research
Franco, Rafael Alves
de Almeida, Juliano Pinheiro
Landoni, Giovanni
Scheeren, Thomas W. L.
Galas, Filomena Regina Barbosa Gomes
Fukushima, Julia Tizue
Zefferino, Suely
Nardelli, Pasquale
de Albuquerque Piccioni, Marilde
Arita, Elisandra Cristina Trevisan Calvo
Park, Clarice Hyesuk Lee
Cunha, Ligia Cristina Camara
de Oliveira, Gisele Queiroz
Costa, Isabela Bispo Santos da Silva
Kalil Filho, Roberto
Jatene, Fabio Biscegli
Hajjar, Ludhmila Abrahão
Dobutamine-sparing versus dobutamine-to-all strategy in cardiac surgery: a randomized noninferiority trial
title Dobutamine-sparing versus dobutamine-to-all strategy in cardiac surgery: a randomized noninferiority trial
title_full Dobutamine-sparing versus dobutamine-to-all strategy in cardiac surgery: a randomized noninferiority trial
title_fullStr Dobutamine-sparing versus dobutamine-to-all strategy in cardiac surgery: a randomized noninferiority trial
title_full_unstemmed Dobutamine-sparing versus dobutamine-to-all strategy in cardiac surgery: a randomized noninferiority trial
title_short Dobutamine-sparing versus dobutamine-to-all strategy in cardiac surgery: a randomized noninferiority trial
title_sort dobutamine-sparing versus dobutamine-to-all strategy in cardiac surgery: a randomized noninferiority trial
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7838231/
https://www.ncbi.nlm.nih.gov/pubmed/33496877
http://dx.doi.org/10.1186/s13613-021-00808-6
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