1 / 29

Prime Time ! Fluids during Cardiac Surgery

This article examines the critical role of fluid management during cardiac surgery, particularly the effects of different priming solutions and fluid types on patient outcomes. It discusses aspects such as preoperative anemia, perioperative transfusions, and postoperative complications, along with the mechanisms by which fluid choice may influence inflammation and blood damage. Key findings highlight the importance of using colloids in circuit primes and balanced solutions to enhance acid-base status. The review synthesizes various studies to provide insights into best practices for optimizing fluid strategies in this high-risk setting.

vernon
Download Presentation

Prime Time ! Fluids during Cardiac Surgery

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Prime Time !Fluids during Cardiac Surgery Dirk Himpe MD PhD MHE EDIC ZNA Middelheim General Hospital Antwerp Belgium

  2. Outcome ?

  3. Engoren et al. Ann Thorac Surg 2002; 74:1 180-6

  4. Koch CC et al. Ann Thorac Surg 2006; 81:1650-7.

  5. Carson J, Lancet 1996, 348: 1055-60

  6. Factors: .preoperative anemia, .perioperative RBC transfusions .postoperative re-exploration

  7. Weight gain after cardiac surgery < 10 % 10-20 % > 20 % 0 20 40 60 80 100 Mortality % Lowell, CCM 1990 18:728, 1990

  8. Red blood cell Platelet INFLAMMATION Polymer Blood 1994; 4:3175-81

  9. phases: pre-pump-post-ICU targets: interrelated .transfusion/anemia .acid-base status .fluid balance (colloids) .inflammation (SIRS) OR

  10. The “pump”: onset of CPB = massive fluid load bloodvolume + priming solution Htc: 20-25 % 45 % start CPB (few minutes)

  11. Issue: Type of Fluid = Determinant of Outcome ?! (direct or indirect)

  12. Blood-loss

  13. Fluid-Balance

  14. James A. Russel. JCTVA 2004, 18: 429-437

  15. Himpe D, Act Anaesth Belg, 54:207-15, 2003

  16. Acid-Base

  17. Base Excess (mean ± 1.96SEM) Succinyl-linkedGEL in buffered vehicle Albumin-Hartmann Urea-linked GEL in NS Himpe D. et al. JCTVA 1991, 5:457-66

  18. Base Excess (mean ±SD) Hydroxyethyl Starch 6% 130/0.4 in a Balanced Electrolyte Solution (Volulyte) Hydroxyethyl Starch 6% 130/0.4 in NS (Voluven) Base EM. et al. JCTVA 2011, 25:407-14

  19. damage to figured blood elements (foreign surfaces, air, pericardium & pumps)

  20. free haemoglobin -> inflammation 1200 mg/L mechanical stress on blood during CPB 1000 800 electrically charged 4% MFGelatine 4% Albumin 600 6% HES 70/0.5 Normal Saline 400 200 0 120 min baseline Sumpelmann R et al. Anaesthesia 55: 976, 2000

  21. Himpe D, Act Anaesth Belg, 54:207-15, 2003

  22. Mortality

  23. Comparison of types of priming solutions used for CPB with the survival rate of coronary bypass patients. NS I. crystalloid (211 pts) II. 25 % human albumin (217 pts) III. 6% hetastarch (298 pts) IV. 6% hetastarch & 25% human albumin (161 pts) Canver C. C. & Nichols R. D. Chest 2000;118:1616-1620

  24. Himpe D, Act Anaesth Belg, 54:207-15, 2003

  25. Conclusions from the available evidence to date: • outcome after cardiac surgery: • there is more than priming fluids between heaven and earth; • but: - always colloids in the CPB prime; - electrically charged colloids may reduce blood damage (inflammation ?); - balanced solutions abolish the CPB acid-base problem; • minimizing volume of extracorporeal circuits may help;

More Related