Abstract

MUNOZ, Luis A et al. Inotropes in postoperative cardiovascular surgery: cross-sectional study. Rev. Colomb. Cardiol. [online]. 2014, vol.21, n.4, pp.258-263. ISSN 0120-5633.  https://doi.org/10.1016/j.rccar.2014.05.005.

Background: Inotropes are frequently used in the intensive care unit to maintain tissue perfusion in case of shock while the cause is resolved. Patients who undergo cardiovascular surgery will frequently require treatment with these drugs during postoperative care. Aim: To describe the frequency and type of drugs used for the hemodynamic support of patients during the postoperative period of elective cardiovascular surgery at ClínicaFundadores, Bogotá D.C. Methods: Cross-sectional study. All patients in the postoperative period of cardiovascular surgery admitted to the intensive care unit (ICU) without pharmacologic hemodynamic support between October and December 2011 were included. The following variables were obtained from the electronic medical records: age, sex, EuroSCORE, pre-surgical diagnosis, use of cardiopulmonary bypass (CPB), use of vasoactive drugs, days of ICU stay and mortality. Results: One-hundred fifty cases of cardiovascular surgery were found. Patients had a mean age of 62.8 years (SD 10.5), of whom 97 (64.6%) were men. Risk according to Euro SCORE was high in 22 (15%) cases, moderate in 93 (62%) and low in 35 (23%) cases. Pre-surgical diagnoses included coronary artery disease in 105 (70%) patients, valvular disease in 29 (19%) patients, ischemic and valvular cardiomyopathy in 9 patients (6%) and atrial septal defect in 6 (4%) patients. CPB was used in 57 (38%) cases with a median (IQR) time of 92 (73-114) minutes, of whom 55 (52%) patients were operated with aortic clamp, with a median (IQR) time of 75 (52-90) minutes. In 78 (52%) patients one or more vasoactive drugs were used, where adrenaline was used most often (41 patients, 27%). In 22 (15%) patients inodilators were required. These patients received dobutamine. Median (IQR) ICU stay was 3 (2-4) days and 6 (4.7%) patients died. Conclusion: In almost half of patients in the postoperative period of cardiovascular surgery an inotrope was used; the most frequently being adrenaline followed by norepinephrine. The inodilator used in these patients was dobutamine. No calcium sensitizer inotropes were used and in few cases phosphodiesterase III inhibitors were used with comparable ICU stay and mortality to research in other populations.

Keywords : Catecholamine; Cardiac surgery; Ischemic cardiomyopathy.

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