{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:34:22Z","timestamp":1787841262260,"version":"build-2784847793"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2017,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>There has been a constant emphasis on developing management strategies to improve the outcome of high-risk cardiac patients undergoing surgical revascularization. The performance of coronary artery bypass surgery on an off-pump coronary artery bypass (OPCAB) avoids the risks associated with extra-corporeal circulation. The preliminary results of goal-directed therapy (GDT) for hemodynamic management of high-risk cardiac surgical patients are encouraging. The present study was conducted to study the outcome benefits with the combined use of GDT with OPCAB as compared to the conventional hemodynamic management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Method:<\/jats:title>\n                    <jats:p>\n                      Patients with the European System for Cardiac Operative Risk Evaluation \u22653 scheduled for OPCAB were randomly divided into two groups; the control and GDT groups. The GDT group included the monitoring and optimization of advanced parameters, including cardiac index (CI), systemic vascular resistance index, oxygen delivery index, stroke volume variation; continuous central venous oxygen saturation (ScVO\n                      <jats:sub>2<\/jats:sub>\n                      ), global end-diastolic volume, and extravascular lung water (EVLW), using FloTrac\u2122, PreSep\u2122, and EV-1000\n                      <jats:sup>\u00ae<\/jats:sup>\n                      monitoring panels, in addition to the conventional hemodynamic management in the control group. The hemodynamic parameters were continuously monitored for 48 h in Intensive Care Unit (ICU) and corrected according to GDT protocol. A total of 163 patients consented for the study.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Result:<\/jats:title>\n                    <jats:p>Seventy-five patients were assigned to the GDT group and 88 patients were in the control group. In view of 9 exclusions from the GDT group and 12 exclusions from control group, 66 patients in the GDT group and 76 patients in control group completed the study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>\n                      The length of stay in hospital (LOS-H) (7.42 \u00b1 1.48 vs. 5.61 \u00b1 1.11 days,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001) and ICU stay (4.2 \u00b1 0.82 vs. 2.53 \u00b1 0.56 days,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001) were significantly lower in the GDT group as compared to control group. The duration of inotropes (3.24 \u00b1 0.73 vs. 2.89 \u00b1 0.68 h,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.005) was also significantly lower in the GDT group. The two groups did not differ in duration of ventilated hours, mortality, and other complications. The parameters such as ScVO\n                      <jats:sub>2<\/jats:sub>\n                      , CI, and EVLW had a strong negative and positive correlation with the LOS-H with\n                      <jats:italic toggle=\"yes\">r<\/jats:italic>\n                      values of \u2212 0.331, \u22120.319, and 0.798, respectively. The study elucidates the role of a goal-directed hemodynamic optimization for improved outcome in high-risk cardiac patients undergoing OPCAB.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/0971-9784.197842","type":"journal-article","created":{"date-parts":[[2017,1,10]],"date-time":"2017-01-10T22:47:13Z","timestamp":1484088433000},"page":"83-89","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":37,"title":["Goal-directed Therapy Improves the Outcome of High-risk Cardiac Patients Undergoing Off-pump Coronary Artery Bypass"],"prefix":"10.4103","volume":"20","author":[{"given":"Poonam Malhotra","family":"Kapoor","sequence":"first","affiliation":[{"name":"From the Department of Cardiac Anaesthesia, Cardio Thoracic Centre, AIIMS, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohan","family":"Magoon","sequence":"additional","affiliation":[{"name":"From the Department of Cardiac Anaesthesia, Cardio Thoracic Centre, AIIMS, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajinder Singh","family":"Rawat","sequence":"additional","affiliation":[{"name":"Department of Cardiac Anaesthesiology, Salalah Heart Center, Salalah, Sultanate of Oman"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yatin","family":"Mehta","sequence":"additional","affiliation":[{"name":"Department of Critical Care and Anaesthesiology, Medanta \u2013 The Medicity, Gurgaon, Haryana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sameer","family":"Taneja","sequence":"additional","affiliation":[{"name":"Department of Cardiac Anaesthesia, Naval Base Hospital, Mumbai, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R","family":"Ravi","sequence":"additional","affiliation":[{"name":"Department of Statistics, Lady Shri Ram College, University of Delhi, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milind P","family":"Hote","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, AIIMS, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R2-20250920","doi-asserted-by":"crossref","first-page":"1176","DOI":"10.1378\/chest.94.6.1176","article-title":"Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients","volume":"94","author":"Shoemaker","year":"1988","journal-title":"Chest"},{"key":"R3-20250920","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1136\/bmj.318.7191.1099","article-title":"Reducing the risk of major elective surgery: Randomised controlled trial of preoperative optimisation of oxygen delivery","volume":"318","author":"Wilson","year":"1999","journal-title":"BMJ"},{"key":"R4-20250920","doi-asserted-by":"crossref","first-page":"638","DOI":"10.4103\/0971-9784.191552","article-title":"Perioperative utility of goal-directed therapy in high-risk cardiac patients undergoing coronary artery bypass grafting: \u201cA clinical outcome and biomarker-based study\u201d","volume":"19","author":"Kapoor","year":"2016","journal-title":"Ann Card Anaesth"},{"key":"R5-20250920","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1016\/S1010-7940(02)00009-X","article-title":"Hemodynamic changes during off-pump CABG surgery","volume":"21","author":"Do","year":"2002","journal-title":"Eur J Cardiothorac Surg"},{"key":"R6-20250920","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1161\/01.CIR.38.5.941","article-title":"Measurement of central venous oxygen saturation in patients with myocardial infarction","volume":"38","author":"Goldman","year":"1968","journal-title":"Circulation"},{"key":"R7-20250920","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1097\/00000542-197205000-00012","article-title":"Central venous oxygen saturation in shock: A study in man","volume":"36","author":"Lee","year":"1972","journal-title":"Anesthesiology"},{"key":"R8-20250920","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1136\/bmj.38156.767118.7C","article-title":"Randomised controlled trial assessing the impact of a nurse delivered, flow monitored protocol for optimisation of circulatory status after cardiac surgery","volume":"329","author":"McKendry","year":"2004","journal-title":"BMJ"},{"key":"R9-20250920","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1093\/bja\/aei223","article-title":"Intraoperative oesophageal Doppler guided fluid management shortens postoperative hospital stay after major bowel surgery","volume":"95","author":"Wakeling","year":"2005","journal-title":"Br J Anaesth"},{"key":"R10-20250920","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1097\/00000542-200210000-00012","article-title":"Goal-directed intraoperative fluid administration reduces length of hospital stay after major surgery","volume":"97","author":"Gan","year":"2002","journal-title":"Anesthesiology"},{"key":"R11-20250920","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1053\/j.jvca.2006.08.004","article-title":"Cardiac output determination from the arterial pressure wave: Clinical testing of a novel algorithm that does not require calibration","volume":"21","author":"Manecke","year":"2007","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"R12-20250920","doi-asserted-by":"crossref","first-page":"R105","DOI":"10.1186\/cc6125","article-title":"Validation of a continuous, arterial pressure-based cardiac output measurement: A multicenter, prospective clinical trial","volume":"11","author":"McGee","year":"2007","journal-title":"Crit Care"},{"key":"R13-20250920","doi-asserted-by":"crossref","first-page":"121","DOI":"10.4103\/0971-9784.37937","article-title":"Comparison of simultaneous estimation of cardiac output by four techniques in patients undergoing off-pump coronary artery bypass surgery: A prospective observational study","volume":"10","author":"Chakravarthy","year":"2007","journal-title":"Ann Card Anaesth"},{"key":"R14-20250920","doi-asserted-by":"crossref","first-page":"394","DOI":"10.1053\/j.jvca.2008.02.015","article-title":"Cardiac output monitoring: Comparison of a new arterial pressure waveform analysis to the bolus thermodilution technique in patients undergoing off-pump coronary artery bypass surgery","volume":"22","author":"Mehta","year":"2008","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"R15-20250920","doi-asserted-by":"crossref","first-page":"R98","DOI":"10.1186\/cc11366","article-title":"Clinical validation of a new thermodilution system for the assessment of cardiac output and volumetric parameters","volume":"16","author":"Kiefer","year":"2012","journal-title":"Crit Care"},{"key":"R16-20250920","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1007\/s00134-006-0404-2","article-title":"Goal-directed fluid management reduces vasopressor and catecholamine use in cardiac surgery patients","volume":"33","author":"Goepfert","year":"2007","journal-title":"Intensive Care Med"},{"key":"R17-20250920","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1097\/ACO.0b013e3282f4db7a","article-title":"Early goal-directed therapy in severe sepsis and septic shock: A contemporary review of the literature","volume":"21","author":"Rivers","year":"2008","journal-title":"Curr Opin Anaesthesiol"},{"key":"R18-20250920","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1111\/j.1399-6576.2008.01855.x","article-title":"Single transpulmonary thermodilution and continuous monitoring of central venous oxygen saturation during off-pump coronary surgery","volume":"53","author":"Smetkin","year":"2009","journal-title":"Acta Anaesthesiol Scand"},{"key":"R19-20250920","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1186\/cc3951","article-title":"Goal directed therapy: How long can we wait?","volume":"9","author":"Gordon","year":"2005","journal-title":"Crit Care"},{"key":"R20-20250920","doi-asserted-by":"crossref","first-page":"R687","DOI":"10.1186\/cc3887","article-title":"Early goal-directed therapy after major surgery reduces complications and duration of hospital stay. A randomised, controlled trial [ISRCTN38797445]","volume":"9","author":"Pearse","year":"2005","journal-title":"Crit Care"},{"key":"R21-20250920","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1093\/bja\/aet020","article-title":"Goal-directed therapy in cardiac surgery: A systematic review and meta-analysis","volume":"110","author":"Aya","year":"2013","journal-title":"Br J Anaesth"}],"container-title":["Annals of Cardiac Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/00660469-201720010-00017","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T13:47:40Z","timestamp":1787838460000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/00660469-201720010-00017"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,1]]},"references-count":20,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2017]]}},"URL":"https:\/\/doi.org\/10.4103\/0971-9784.197842","relation":{},"ISSN":["0971-9784","0974-5181"],"issn-type":[{"value":"0971-9784","type":"print"},{"value":"0974-5181","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,1]]},"assertion":[{"value":"2016-12-01","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-12-01","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}