Reduction of Early Postoperative Morbidity in Cardiac Surgery Patients Treated With Continuous Veno–Venous Hemofiltration During Cardiopulmonary Bypass

Abstract

Cardiac surgery with cardiopulmonary bypass is associated with a systemic inflammatory response syndrome. The major clinical features of this include a reduction of pulmonary compliance and increased extracellular fluids, with increased pulmonary shunt fraction similar to acute respiratory distress syndrome, thus resulting in prolonged mechanical ventilation time (VAM) and intensive care unit length of stay (ICU STAY). We evaluated the feasibility of an intraoperatory cardiopulmonary bypass (CPB) circuit connected with a monitor for continuous veno-venous hemofiltration (CVVH) to ameliorate pulmonary function after open heart surgery reducing VAM and ICU STAY. Forty patients undergoing elective coronary artery bypass grafting were randomized at the time of surgery into a control group (20 patients who received standard cardiopulmonary bypass) and a study group (20 patients who received CVVH during cardiopulmonary bypass). The analysis of postoperative variables showed a significative reduction of VAM in treated group (CVVH group mean 3.55 h +/- 0.85, control group 5.8 h +/- 0.94, P < 0.001) and ICU STAY (CVVH group mean 29.5 h +/- 6.7, control group 40.5 h +/- 6.67, P < 0.001). In our experience, the use of intraoperatory CVVH during cardiopulmonary bypass is associated with lower early postoperative morbidity.

Continuous Ultrafiltration Enhances Recovery After Adult Cardiac Surgery With Cardiopulmonary Bypass: A Systematic Review and Meta-analysis

“…A total of 646 abstracts and 20 full-text articles were assessed for eligibility, yielding 12 RCTs, consisting of 989 patients, that were included in the meta-analysis ( Table 1 ). 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 A large range was found in study publication dates (1997-2020); types of continuous ultrafiltration used in the intervention arm (CUF, ZBUF, SBUF, CUF-MUF); and types of cardiac intervention (coronary artery bypass grafting, valvular, concomitant coronary artery bypass grafting-valve, and aortic surgery). The intraoperative data from included studies are reported in Table 2 .…”

“…17 (2006) 100 CABG (NR) Valvular (NR) Excluded renal insufficiency CUF 63 ± 12 79 NR Low No UF 64 ± 10 74 NR Low Luciani et al. 18 (2009) 40 CABG (100) Excluded severe comorbidities SBUF 66.1 ± 11.1 NR NR Low No UF 65.2 ± 8.4 NR NR Low Santarpino et al. 19 (2009) 24 CABG (100) Elective, excluded LVEF < 40%, redo surgery, recent MI and severe comorbidities CUF 63.3 ± 9.2 75 ASA score: 3.1 ± 1.6 Low Steroids ∗ 59.3 ± 10.1 75 ASA score 2.8 ± 1.1 Low Zhang et al.…”

“…17 (2006) 100 CABG (NR) Valvular (NR) > 400 mL/15 min CUF 103 ± 51 69 ± 32 5871 ± 2612 No UF 96 ± 36 65 ± 23 0 Luciani et al. 18 (2009) 40 CABG (100) 35 mL/kg per h SBUF 112 ± 33 64 ± 24 NR No UF 110 ± 29 63 ± 23 0 Santarpino et al. 19 (2009) 24 CABG (100) NR CUF 71 ± 11 56 ± 8 NR Steroids ∗ 85 ± 22 67 ± 16 0 Zhang et al.…”

Fluid Accumulation Dilemma in the Critically Ill Children, A Retrospective Study

“…[15] There isn't any standard definition of fluid load in current literature, and there is no guideline to manage it. [1,16] In the literature, prevention of fluid accumulation children has been associated with better survival, [17,18] and increased fluid load with increased mortality. [11,19] The first-line therapy to increase output in fluid management is diuretics.…”

Artificial Organs 2009: A Year in Review

“…Remo Luciani et al. (82) of the University of Rome, Rome, Italy evaluated the feasibility of an intraoperatory CPB circuit connected with a monitor for continuous venovenous hemofiltration (CVVH) to ameliorate pulmonary function after open heart surgery reducing mechanical ventilation time (VAM) and intensive care unit (ICU) stay. Forty patients undergoing elective coronary artery bypass grafting were randomized at the time of surgery into a control group (20 patients who received standard CPB) and a study group (20 patients who received CVVH during CPB).…”