High Versus Normal Blood Pressure Targets in Relation to Right Ventricular Dysfunction After Cardiac Surgery: A Randomized Controlled Trial

Inge T Bootsma; Fellery de Lange; Thomas W L Scheeren; Jayant S Jainandunsing; E Christiaan Boerma

doi:10.1053/j.jvca.2021.02.054

High Versus Normal Blood Pressure Targets in Relation to Right Ventricular Dysfunction After Cardiac Surgery: A Randomized Controlled Trial

Inge T Bootsma^*, Fellery de Lange, Thomas W L Scheeren, Jayant S Jainandunsing, E Christiaan Boerma

^*Corresponding author for this work

Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE)

Research output: Contribution to journal › Article › Academic › peer-review

2 Citations (Scopus)

112 Downloads (Pure)

Abstract

Objective: Management of right ventricular (RV) dysfunction is challenging. Current practice predominantly is based on data from experimental and small uncontrolled studies and includes augmentation of blood pressure. However, whether such intervention is effective in the clinical setting of cardiac surgery is unknown.

Design: Randomized controlled trial.

Setting: Single-center study in a tertiary teaching hospital.

Participants: The study comprised 78 patients equipped with a pulmonary artery catheter (PAC), classified according to PAC-derived RV ejection fraction (RVEF); 44 patients had an RVEF of = 20% and

Interventions: Patients randomly were assigned to either a normal target group (mean arterial pressure 65 mmHg) or a high target group [mean arterial pressure 85 mmHg]). The primary end- point was the change in RVEF over a one-hour study period.

Measurements and Main Results: There was no significant between-group difference in change of RVEF

Conclusion: In a mixed cardiac surgery population with RV dysfunction, norepinephrine-mediated high blood pressure targets did not result in an increase in PAC-derived RVEF compared with normal blood pressure targets. (C) 2021 The Authors. Published by Elsevier Inc.

Original language	English
Pages (from-to)	2980-2990
Number of pages	11
Journal	Journal of cardiothoracic and vascular anesthesia
Volume	35
Issue number	10
Early online date	2021
DOIs	https://doi.org/10.1053/j.jvca.2021.02.054
Publication status	Published - Oct-2021

Keywords

bloodpressure targets
right ventricular dysfunction
pulmonary artery catheter
transesophageal echocardiography
cardiac surgery
HEART-FAILURE
SEPTIC SHOCK
VOLUME OVERLOAD
NOREPINEPHRINE
MANAGEMENT
PATHOPHYSIOLOGY
VASOPRESSORS
STATEMENT
OUTPUT
ARTERY

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title = "High Versus Normal Blood Pressure Targets in Relation to Right Ventricular Dysfunction After Cardiac Surgery: A Randomized Controlled Trial",

abstract = "Objective: Management of right ventricular (RV) dysfunction is challenging. Current practice predominantly is based on data from experimental and small uncontrolled studies and includes augmentation of blood pressure. However, whether such intervention is effective in the clinical setting of cardiac surgery is unknown.Design: Randomized controlled trial.Setting: Single-center study in a tertiary teaching hospital.Participants: The study comprised 78 patients equipped with a pulmonary artery catheter (PAC), classified according to PAC-derived RV ejection fraction (RVEF); 44 patients had an RVEF of = 20% andInterventions: Patients randomly were assigned to either a normal target group (mean arterial pressure 65 mmHg) or a high target group [mean arterial pressure 85 mmHg]). The primary end- point was the change in RVEF over a one-hour study period.Measurements and Main Results: There was no significant between-group difference in change of RVEFConclusion: In a mixed cardiac surgery population with RV dysfunction, norepinephrine-mediated high blood pressure targets did not result in an increase in PAC-derived RVEF compared with normal blood pressure targets. (C) 2021 The Authors. Published by Elsevier Inc.",

keywords = "bloodpressure targets, right ventricular dysfunction, pulmonary artery catheter, transesophageal echocardiography, cardiac surgery, HEART-FAILURE, SEPTIC SHOCK, VOLUME OVERLOAD, NOREPINEPHRINE, MANAGEMENT, PATHOPHYSIOLOGY, VASOPRESSORS, STATEMENT, OUTPUT, ARTERY",

author = "Bootsma, {Inge T} and {de Lange}, Fellery and Scheeren, {Thomas W L} and Jainandunsing, {Jayant S} and Boerma, {E Christiaan}",

year = "2021",

month = oct,

doi = "10.1053/j.jvca.2021.02.054",

language = "English",

volume = "35",

pages = "2980--2990",

journal = "Journal of cardiothoracic and vascular anesthesia",

issn = "1053-0770",

publisher = "W B SAUNDERS CO-ELSEVIER INC",

number = "10",

}

High Versus Normal Blood Pressure Targets in Relation to Right Ventricular Dysfunction After Cardiac Surgery: A Randomized Controlled Trial. / Bootsma, Inge T; de Lange, Fellery; Scheeren, Thomas W L et al.
In: Journal of cardiothoracic and vascular anesthesia, Vol. 35, No. 10, 10.2021, p. 2980-2990.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - High Versus Normal Blood Pressure Targets in Relation to Right Ventricular Dysfunction After Cardiac Surgery

T2 - A Randomized Controlled Trial

AU - Bootsma, Inge T

AU - de Lange, Fellery

AU - Scheeren, Thomas W L

AU - Jainandunsing, Jayant S

AU - Boerma, E Christiaan

PY - 2021/10

Y1 - 2021/10

N2 - Objective: Management of right ventricular (RV) dysfunction is challenging. Current practice predominantly is based on data from experimental and small uncontrolled studies and includes augmentation of blood pressure. However, whether such intervention is effective in the clinical setting of cardiac surgery is unknown.Design: Randomized controlled trial.Setting: Single-center study in a tertiary teaching hospital.Participants: The study comprised 78 patients equipped with a pulmonary artery catheter (PAC), classified according to PAC-derived RV ejection fraction (RVEF); 44 patients had an RVEF of = 20% andInterventions: Patients randomly were assigned to either a normal target group (mean arterial pressure 65 mmHg) or a high target group [mean arterial pressure 85 mmHg]). The primary end- point was the change in RVEF over a one-hour study period.Measurements and Main Results: There was no significant between-group difference in change of RVEFConclusion: In a mixed cardiac surgery population with RV dysfunction, norepinephrine-mediated high blood pressure targets did not result in an increase in PAC-derived RVEF compared with normal blood pressure targets. (C) 2021 The Authors. Published by Elsevier Inc.

AB - Objective: Management of right ventricular (RV) dysfunction is challenging. Current practice predominantly is based on data from experimental and small uncontrolled studies and includes augmentation of blood pressure. However, whether such intervention is effective in the clinical setting of cardiac surgery is unknown.Design: Randomized controlled trial.Setting: Single-center study in a tertiary teaching hospital.Participants: The study comprised 78 patients equipped with a pulmonary artery catheter (PAC), classified according to PAC-derived RV ejection fraction (RVEF); 44 patients had an RVEF of = 20% andInterventions: Patients randomly were assigned to either a normal target group (mean arterial pressure 65 mmHg) or a high target group [mean arterial pressure 85 mmHg]). The primary end- point was the change in RVEF over a one-hour study period.Measurements and Main Results: There was no significant between-group difference in change of RVEFConclusion: In a mixed cardiac surgery population with RV dysfunction, norepinephrine-mediated high blood pressure targets did not result in an increase in PAC-derived RVEF compared with normal blood pressure targets. (C) 2021 The Authors. Published by Elsevier Inc.

KW - bloodpressure targets

KW - right ventricular dysfunction

KW - pulmonary artery catheter

KW - transesophageal echocardiography

KW - cardiac surgery

KW - HEART-FAILURE

KW - SEPTIC SHOCK

KW - VOLUME OVERLOAD

KW - NOREPINEPHRINE

KW - MANAGEMENT

KW - PATHOPHYSIOLOGY

KW - VASOPRESSORS

KW - STATEMENT

KW - OUTPUT

KW - ARTERY

U2 - 10.1053/j.jvca.2021.02.054

DO - 10.1053/j.jvca.2021.02.054

M3 - Article

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SN - 1053-0770

VL - 35

SP - 2980

EP - 2990

JO - Journal of cardiothoracic and vascular anesthesia

JF - Journal of cardiothoracic and vascular anesthesia

IS - 10

ER -

High Versus Normal Blood Pressure Targets in Relation to Right Ventricular Dysfunction After Cardiac Surgery: A Randomized Controlled Trial

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