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Ann Thorac Surg 1992;54:517-522
© 1992 The Society of Thoracic Surgeons
a Division of Cardiothoracic Surgery, East Carolina University School of Medicine, Greenville, North Carolina USA
b Department of Thoracic and Cardiothoracic Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio USA
Accepted for publication February 10, 1992.
* Address reprint requests to Dr Chitwood, Division of Cardiothoracic Surgery, East Carolina University School of Medicine, Greenville, NC 27858-4354.
Hypertension is common after a cardiac operation and may result in postoperative hemorrhagic and other complications. Most often this problem has been treated using manually controlled doses of intravenous sodium nitroprusside. To evaluate the clinical impact of an automated closed-loop administration system on patients after cardiotomy, a prospective trial was conducted at nine clinical centers. Patients with hypertension were managed by either manual nitroprusside titration (n = 532) or a closed-loop automated titration system (n = 557). Patient groups were not significantly different in age, weight, or height. Moreover, the types of surgical procedures were comparable: primary coronary artery bypass grafting, 59.2% and 58.9%, manual group versus automated group; repeat coronary artery bypass grafting, 10.5% and 8.6%, respectively; valve procedures, 11.3% and 15.1%, respectively; and other cardiac procedures, 19.0% and 17.4%, respectively (all p = not significant). The automated group showed a significant reduction in the number of hypertensive episodes per patient (1.8 ± 0.2 versus 0.6 ± 0.07; p = 0.0001. At the same time, the number of hypotensive episodes per patient was reduced with automated closed-loop titration (0.40 ± 0.05 versus 0.30 ± 0.03; p = 0.02). Chest tube drainage (866 ± 37 mL versus 693 ± 23 mL [mean ± standard error of the mean]; p = 0.0001), percentage of patients receiving transfusion (40.0% versus 33.0%; p = 0.02), and total amount transfused (2.4 ± 0.12 units versus 2.0 ± 0.10 units; p = 0.0003) were all reduced significantly by the use of an automated titration system. Finally, of the 3.3% of all patients in the series who required reexploration for bleeding, almost twice as many had been managed by manual infusion compared with automated titration. These data suggest that the automated control of nitroprusside infusion may result in improved patient outcome through more effective control of hypertension, a decreased incidence of therapy-induced hypotension, a reduction in postoperative bleeding, decreased transfusion requirements, and a probable decreased incidence of reexploration for post-operative bleeding.
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