The influence of vascular pressure and different primes on the fluid balance of, and oxygen supply to, the patient during CABG

Ja, Sirs; Glenville, Brian; Stanbridge, RL; Sogliani, Franco; Stavrides, George; Griffiths, AW Harrop; Sandoval, Juan Pablo; Macleod, K. W.; Akins, Amy; Powell, Jack H.; Davis, Shyrin C.A.T.

doi:10.1177/026765919501000107

Cited by 4 publications

(3 citation statements)

References 6 publications

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“…24,25 Otherwise, at lower arterial blood pressures during CBP-related surgery, the reduction of plasma oncotic pressure using crystalloid priming is beneficial: the cited study showed that optimal oxygen exchange is achieved by the equilibration of plasma oncotic pressure and capillary hydrostatic pressure without altering the interstitial fluid volume. 26 Lactate accumulation as a surrogate parameter for tissue perfusion and oxygenation 27 is described as being reduced by RAP. 28 Although lactate levels were higher in patients treated with crystalloid compared with albumin 12 hours after surgery in our study, the difference was marginal and similar levels were observed at other time intervals.…”

Section: Discussionmentioning

confidence: 99%

Impact of Crystalloid or Albumin Priming of the Heart–Lung Machine on Inhospital Outcome after Coronary Artery Bypass Surgery

Weiler¹,

Hamiko²,

Mellert³

et al. 2018

Thorac cardiovasc Surg

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Section: Discussionmentioning

confidence: 99%

Impact of Crystalloid or Albumin Priming of the Heart–Lung Machine on Inhospital Outcome after Coronary Artery Bypass Surgery

Weiler¹,

Hamiko²,

Mellert³

et al. 2018

Thorac cardiovasc Surg

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“…It is well documented that the use of cardiopulmonary bypass (CPB) is associated with the development of significant systemic inflammatory response syndrome (SIRS) (57,58) which can affect patient outcomes. SIRS is characterized by high cardiac output, low mean and systolic blood pressure, low systemic vascular resistance, and a core temperature greater than 38°C or less than 36°C in the immediate postoperative period.…”

Section: Platelet Inhibition and Cardiopulmonary Bypassmentioning

confidence: 99%

A Review of Antiplatelet Drugs, Coronary Artery Diseases and Cardiopulmonary Bypass

Ren¹,

Patel²,

Crane³

2010

J Extra Corpor Technol

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Platelets play a major role in the thromboembolic diseases and upon vascular injury, especially arterial vascular injury. These platelets rapidly adhere to the exposed subendothelial area, where they become activated by contacting with stimulants. Antiplatelet therapy remains extremely important in treatment and prophylaxis of arterial thromboembolic disorders such as coronary arterial diseases and stroke. The antiplatelet drugs (APDs) are among the most widely used in the world. Based on the molecular targets, APDs are classified as Thromboxane A2 pathway blockers, ADP receptor antagonists, GPIIa/IIIb antagonists, adenosine reuptake inhibitors, phosphodiesterase inhibitors, thrombin receptor inhibitors, and others. Coronary artery bypass graft (CABG) surgery is an important therapeutic approach to treat coronary artery disease. Long-term success after CABG depends on the patency of the bypass vessels. Since platelets play a crucial role in the pathogenesis of thrombosis in the blood vessels, APDs are broadly used to reduce serious cardiovascular events. Platelets also are an integral part of inflammation and APDs have demonstrated to reduce the inflammation mediators in the healthy volunteers and coronary artery disease patients; it will be an interesting topic to determine if platelet inhibition will attenuate CPB-induced systemic inflammatory response syndrome. Due to concerns of post-op bleeding with use of APDs, it is a common practice to withhold APDs prior to surgery; however, recent studies have demonstrated that continuation of APDs prior to surgery (even until the day of surgery) does not increase the risk of post-op bleeding. With extensive use of APDs in cardiovascular thromboembolic events, APD resistance becomes problematic in clinical antiplatelet therapy. Since there is no standardized or universal definition available to quantify APDs resistance, a clinically meaningful definition of APD resistance needs to be developed based on data linking laboratory tests to clinical outcomes in patients.

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“… 10 In contrast, an increased oncotic pressure is beneficial for maintaining a sufficient mean arterial pressure (MAP) and has been shown to improve organ perfusion. 11 As a consequence, colloids such as human albumin (HA) or hydroxyethyl starch (HES) are often added to the priming solution of the HLM. 12 13 However, a clear advantage for using colloidal solutions could not be demonstrated.…”

Section: Introductionmentioning

confidence: 99%

Mannitol Is Associated with Less Postoperative Delirium after Aortic Valve Surgery in Patients Treated with Bretschneider Cardioplegia

Hamiko¹,

Charitos²,

Velten³

et al. 2020

Thorac Cardiovasc Surg

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Background Heart surgery with extracorporeal circulation (ECC) often leads to postoperative delirium (POD). This is associated with increased morbidity resulting in longer hospital stay and associated costs. The purpose of our study was to analyze the effect of intraoperative mannitol application on POD in patients undergoing elective aortic valve replacement (AVR). Materials and Methods In our retrospective single-center study, 259 patients underwent elective AVR, using Bretschneider cardioplegic solution for cardiac arrest, between 2014 and 2017. Patients were divided in mannitol (n = 188) and nonmannitol (n = 71) groups. POD was assessed using the confusion assessment method for the intensive care unit (ICU). Statistical significance was assumed at p < 0.05. Results Baseline patient characteristics did not differ between the groups. Incidence of POD was significantly higher in the nonmannitol group (33.8 vs. 13.8%; p = 0.001). These patients required longer ventilation time (24.1 vs. 17.1 hours; p = 0.021), higher reintubation rate (11.3 vs. 2.7%; p = 0.009), ICU readmission (12.7 vs. 4.8%; p = 0.026), prolonged ICU (112 vs. 70 hours; p = 0.040), and hospital stay (17.8 vs. 12.6 days; p < 0.001), leading to higher expenses (19,349 € vs. 16,606 €, p < 0.001). A 30-day mortality was not affected, but nonmannitol group showed higher Simplified Acute Physiology Score II score (32.2 vs. 28.7; p < 0.001). Mannitol substitution was independently associated with lower incidence of POD (odds ratio: 0.40; 95% confidence interval: 0.18–0.89; p = 0.02). Conclusion Treatment with mannitol during ECC was associated with decreased incidence of POD. This was accompanied by shorter ventilation time, ICU and hospital stay, and lower treatment expenses.

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The influence of vascular pressure and different primes on the fluid balance of, and oxygen supply to, the patient during CABG

Cited by 4 publications

References 6 publications

Impact of Crystalloid or Albumin Priming of the Heart–Lung Machine on Inhospital Outcome after Coronary Artery Bypass Surgery

Impact of Crystalloid or Albumin Priming of the Heart–Lung Machine on Inhospital Outcome after Coronary Artery Bypass Surgery

A Review of Antiplatelet Drugs, Coronary Artery Diseases and Cardiopulmonary Bypass

Mannitol Is Associated with Less Postoperative Delirium after Aortic Valve Surgery in Patients Treated with Bretschneider Cardioplegia

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