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Post hoc analysis of the glutamics-trial: intravenous glutamate infusion and use of inotropic drugs after cabg
Örebro University, School of Health Sciences. Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
Department of Cardiothoracic Surgery and Cardiothoracic Anaesthesia, Division of Cardiovascular Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
Department of Cardiothoracic Surgery and Cardiothoracic Anaesthesia, Division of Cardiovascular Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
Department of Cardiothoracic and Vascular Surgery Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
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2016 (English)In: BMC Anesthesiology, ISSN 1471-2253, E-ISSN 1471-2253, Vol. 16, no 1, article id 54Article in journal (Refereed) Published
Abstract [en]

Background: Intravenous glutamate reduced the risk of developing severe circulatory failure after isolated coronary artery bypass graft surgery (CABG) for acute coronary syndrome (ACS) in a double-blind randomised clinical trial (GLUTAMICS-ClinicalTrials.gov Identifier: NCT00489827 ). Here our aim was to study if glutamate was associated with reduced the use of inotropes.

Methods: Post-hoc analysis of 824 patients undergoing isolated CABG for ACS in the GLUTAMICS-trial. ICU-records were retrospectively scrutinised including hourly registration of inotropic drug infusion, dosage and total duration during the operation and postoperatively.

Results: ICU-records were found for 171 out of 177 patients who received inotropes perioperatively. Only one fourth of the patients treated with inotropes fulfilled study criteria for postoperative heart failure at weaning from cardiopulmonary bypass (CPB) or later in the ICU. Inotropes were mainly given preemptively to facilitate weaning from CPB or to treat postoperative circulatory instability (bleeding, hypovolaemia). Except for a significantly lower use of epinephrine there were only trends towards lower need of other inotropes overall in the glutamate group. In patients treated with inotropes (glutamate n = 17; placebo n = 13) who fulfilled study criteria for left ventricular failure at weaning from CPB the average duration of inotropic treatment (34 ± 20 v 80 ± 77 h; p = 0.014) and the number of inotropes used (1.35 ± 0.6 v 1.85 ± 0.7; p = 0.047) were lower in the glutamate group.

Conclusions: Intravenous glutamate was associated with a minor influence on inotrope use overall in patients undergoing CABG for ACS whereas a considerable and significant reduction was observed in patients with heart failure at weaning from CPB.

Place, publisher, year, edition, pages
London, United Kingdom: BioMed Central, 2016. Vol. 16, no 1, article id 54
Keywords [en]
Coronary artery bypass surgery, intensive care, postoperative complications, Inotropic drugs, milrinone, epinephrine, glutamate
National Category
Anesthesiology and Intensive Care
Research subject
Anaesthesiology
Identifiers
URN: urn:nbn:se:oru:diva-51615DOI: 10.1186/s12871-016-0216-zISI: 000381573300007PubMedID: 27484576Scopus ID: 2-s2.0-84980384713OAI: oai:DiVA.org:oru-51615DiVA, id: diva2:951508
Funder
Swedish Heart Lung Foundation, 20030595
Note

Funding Agencies:

Capio Research Foundation 2005-1021  2006-1203

Linköping University

Östergötlands Läns Landsting

Available from: 2016-08-09 Created: 2016-08-09 Last updated: 2018-09-13Bibliographically approved

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Vidlund, Mårten

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