Surgeons contest the conclusions drawn from this study
Rapid response to:
Paper
Randomised controlled trial assessing the impact of a nurse delivered, flow monitored protocol for optimisation of circulatory status after cardiac surgery
Surgeons contest the conclusions drawn from this study
We express concern at the conclusions of this study.
We contest, firstly, that this is an invasive intervention with
little demonstrable impact on the primary outcomes cited in the study i.e.
intensive care stay and hospital stay. In fact, both of these figures
exceed the national averages. Average length of stay for all cardiac
surgical patients admitted to the Western Infirmary, Glasgow for example
was 7.2 days for 2004 and has varied little since 1994. A more pertinent
question might be to ask why length of stay is so prolonged in this
group’s experience.
Secondly, important and irrefutable outcomes such as death were
casually dismissed by the authors despite the fact that mortality was
higher in the protocol group than the control group (4 vs. 2). Indeed, one
is forced to go to the web to ascertain the precise circumstances of
death. In that regard, we believe that the term ‘optimisation of
circulatory status’ used throughout the study is presumptive especially
given that multiorgan failure, low cardiac output and cardiac arrest were
cited as causes of death in the protocol patients and that these patients
all arrived in good condition in their intensive care unit (see exclusion
criteria). In the cited morbidities, chest infection and wound infection
were grouped together despite their separate aetiologies and the main
reduction was in the incidence of AF which is not easily explained by the
study and may be a spurious result.
Finally, only 179 patients were recruited from this institution into
the study over almost three years. We are, therefore, drawn to conclude
that this study is representative of only a small and highly selected
group of patients and that its results cannot be widely applicable.
In conclusion, we purport that this study adds nothing to the
scientific literature and that the technique has little to offer patients
undergoing cardiac surgery.
Rapid Response:
Surgeons contest the conclusions drawn from this study
We express concern at the conclusions of this study.
We contest, firstly, that this is an invasive intervention with
little demonstrable impact on the primary outcomes cited in the study i.e.
intensive care stay and hospital stay. In fact, both of these figures
exceed the national averages. Average length of stay for all cardiac
surgical patients admitted to the Western Infirmary, Glasgow for example
was 7.2 days for 2004 and has varied little since 1994. A more pertinent
question might be to ask why length of stay is so prolonged in this
group’s experience.
Secondly, important and irrefutable outcomes such as death were
casually dismissed by the authors despite the fact that mortality was
higher in the protocol group than the control group (4 vs. 2). Indeed, one
is forced to go to the web to ascertain the precise circumstances of
death. In that regard, we believe that the term ‘optimisation of
circulatory status’ used throughout the study is presumptive especially
given that multiorgan failure, low cardiac output and cardiac arrest were
cited as causes of death in the protocol patients and that these patients
all arrived in good condition in their intensive care unit (see exclusion
criteria). In the cited morbidities, chest infection and wound infection
were grouped together despite their separate aetiologies and the main
reduction was in the incidence of AF which is not easily explained by the
study and may be a spurious result.
Finally, only 179 patients were recruited from this institution into
the study over almost three years. We are, therefore, drawn to conclude
that this study is representative of only a small and highly selected
group of patients and that its results cannot be widely applicable.
In conclusion, we purport that this study adds nothing to the
scientific literature and that the technique has little to offer patients
undergoing cardiac surgery.
Competing interests:
None declared
Competing interests: No competing interests