Retrogades autologes priming' verhindert den anstieg des extravasalen lungenwassers während der extrakorporalen zirkulation und verbessert den postoperativen verlauf bei patienten nach koronarer bypassoperation

Translated title of the contribution: Reduced priming volume for CPB prevents extravascular lung water accumulation and post-operative weight gain in CABG patients

Gregory P. Eising, M. Pfauder, M. Niemeyer, P. Tassani, F. Zaccaria, H. Schad, R. Bauernschmitt, R. Lange

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Objective: Sudden crystalloid hemodilution with the onset of cardiopulmonary bypass (CPB) and as a consequence the rapid fall of colloid osmotic pressure is associated with interstitial fluid accumulation leading to post-pump organ dysfunction in cardiac surgery. The discussion of the optimal priming composition for the extracorporeal circulation circuit to avoid or at least to ameliorate post-pump organ dysfunction is still controversial. The following study was undertaken to evaluate whether less hemodilution during cardiopulmonary bypass by retrograde autologous priming can be of benefit in the postoperative course of patients undergoing CABG. Methods: Twenty patients undergoing elective CABG were randomized to either standard prime (SP) volume (1602±202 ml crystalloid prime, n=10) or RAP (395±150 ml). RAP was performed by draining crystalloid prime from the arterial and venous lines into a recirculation bag before CPB. Cardiac index (CI), MAP, PCWP, PVRI, SVRI, PAP, alveolar to arterial oxygen tension difference (AaDO2), pulmonary shunt fraction (Qs/Qt), extravascular lung water (EVLW, double-indicator dilution technique), plasma colloid osmotic pressure (COP), crystalloid fluid balance and body weight were evaluated perioperatively. Results Demographic data and operative parameters were equal for patients in both groups. During CPB, COP was reduced by 54% in the SP group (9.8±2.0 vs. 21.4±2.1 mmHg) and by 41% in the RAP group (12.4±1.1 vs. 20.9±1.8 mmHg) (p< 0.05 SP vs. RAP group). Compared to pre-operatively. EVLW was unchanged in the RAP group 2h post-CPB, but it was elevated by 21% in the SP group (p<05 SP vs. RAP group). End-CPB fluid balance was significantly reduced in the RAP group (1857±521 vs. 2830±635 ml). Post-operative (day 2) weight gain in the SP group could be prevented by RAP (p<0.05) (1.5±1.2 vs. 0.1±0.9 kg). Length of post-operative hospital stay was significantly reduced in the RAP group (6.8±1.0 vs. 9.0±1.6 days). Post-pump cardiopulmonary function did not differ between groups. Conclusions: RAP minimizes excessive fluid administration and the fall of COP during CPB. It prevents post-op EVLW accumulation and weight gain in elective CABG patients resulting in decreased length of hospital stay. RAP can be of benefit especially in high-risk patients with congestive heart failure and/or lung disease.

Translated title of the contributionReduced priming volume for CPB prevents extravascular lung water accumulation and post-operative weight gain in CABG patients
Original languageGerman
Pages (from-to)51-58
Number of pages8
JournalZeitschrift fur Herz-, Thorax- und Gefasschirurgie
Volume16
Issue number2
DOIs
StatePublished - 2002

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