Background Hemodynamic therapy to raise the cardiac index andoxygen delivery to supranormal levels may improve outcomes incritically ill patients. We studied whether increasing the cardiacindex to a supranormal level (cardiac-index group) or increasingmixed venous oxygen saturation to a normal level (oxygen-saturationgroup) would decrease morbidity and mortality among criticallyill patients, as compared with a control group in which thetarget was a normal cardiac index.
Methods A total of 10,726 patients in 56 intensive care unitswere screened, among whom 762 patients belonging to predefineddiagnostic categories with acute physiology scores of 11 orhigher were randomly assigned to the three groups (252 to thecontrol group, 253 to the cardiac-index group, and 257 to theoxygen-saturation group).
Results The hemodynamic targets were reached by 94.3 percentof the control group, 44.9 percent of the cardiac-index group,and 66.7 percent of the oxygen-saturation group (P<0.001).Mortality was 48.4, 48.6, and 52.1 percent, respectively (P= 0.638), up to the time of discharge from the intensive careunit and 62.3, 61.7, and 63.8 percent (P = 0.875) at six months.Among patients who survived, the number of dysfunctional organsand the length of the stay in the intensive care unit were similarin the three groups. No differences in mortality among the threegroups were found for any diagnostic category. A subgroup analysisof the patients in whom hemodynamic targets were reached revealedsimilar mortality rates: 44.8, 40.4, and 39.0 percent, respectively(P = 0.478).
Conclusions Hemodynamic therapy aimed at achieving supranormalvalues for the cardiac index or normal values for mixed venousoxygen saturation does not reduce morbidity or mortality amongcritically ill patients.
Source Information
From the Istituto di Anestesia e Rianimazione, Università di Milano, Ospedale Maggiore di Milano, Istituto di Ricovero e Cura a Carattere Scientifico, Milan (L.G., L.B., P.P.); the Istituto di Ricerche Farmacologiche "Mario Negri," Milan (R.L., G.T.); and the Istituto di Anestesia e Rianimazione, Università di Milano, Ospedale S. Gerardo, Monza (A.P., R.F.) — all in Italy.
Address reprint requests to Professor Gattinoni at the Istituto di Anestesia e Rianimazione, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy.
Goal-Oriented Hemodynamic Therapy
Haupt M. T., Shoemaker W. C., Haddy F. J., Simini B., Gattinoni L., Brazzi L., Pesenti A.
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N Engl J Med 1996;
334:799-800, Mar 21, 1996.
Correspondence
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