Clinical Physiology of Circulation

ISSN 1814-6910 (Print)
ISSN 2410-9134 (Online)

 

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Issue's catalogue ➤ КФК. 2022; 19 (4): 287-392 ➤ Выбор стратегии инфузионной терапии при операциях аортокоронарного шунтирования без искусственного кровообращения

Choice of strategy of infusion therapy in off-pump coronary artery bypass

Authors: Khinchagov D.Ya., Rybka M.M., Mumladze K.V., Golubev E.P., Yudin G.V., Aidashev Yu.Yu., Vorozhka I.V.

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1997-3187-2022-16-3-340-354

UDC: 616.12-005.4-036.12-089.86:615.451.232

Link: Clinical Physiology of Blood Circulaiton. 2022; 4 (19): 338-348

Quote as: Khinchagov D.Ya., Rybka M.M., Mumladze K.V., Golubev E.P., Yudin G.V., Aidashev Yu.Yu., Vorozhka I.V. Choice of strategy of infusion therapy in off-pump coronary artery bypass. Clinical Physiology of Circulation. 2022; 19 (4): 338–48 (in Russ.). DOI: 10.24022/1814-6910-2022-19-4-338-348

Keywords:  fluid therapy off-pump coronary artery bypass

Received / Accepted:  18.07.2022 / 12.10.2022

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Abstract

Objective. To compare the effect of restrictive, liberal and goal-directed fluid therapy on the course of intraoperative and postoperative periods and the duration of mechanical ventilation in off-pump coronary artery bypass (OPCAB).

Material and methods. A single-center retrospective study that included 152 OPCAB patients operated between 2017 and 2018. All patients were divided into 3 groups depending on the strategy of infusion therapy: group 1 with restrictive infusion therapy (RIT) – 48 patients (intraoperative balance (IB) – up to 700 ml), group 2 with liberal infusion therapy (LIT) – 68 patients (IB – from 2200 ml), group 3 goal-directed fluid therapy (GDIT) – 36 patients (IB was – 1207 ± 663 ml). A comparison was made of the oxygenating function of the lungs, the concentration of serum lactate, biochemical parameters and the duration of mechanical ventilation. In the GDIT group, infusion therapy was performed under the control of central hemodynamic data.

Results. According to the results of our study, there were no differences between the groups in the values of arterial oxygen partial pressure (PaO2) in the intraoperative period. At initial values in the groups: RIT – 297.4 ± 95.6, LIT – 288.1 ± 83.3, GDIT – 297.3 ± 94.4 (p = 0.822); there was a statistically insignificant improvement in oxygenation in all groups: RIT – 311.1 ± 91.9, LIT – 298.8 ± 80.9, GDIT – 319.8 ± 80.4 (p = 0.457). Intergroup comparison of statistically significant difference in the duration of mechanical ventilation (h) was not obtained: RIT – 5.0 (4.0; 8), LIT – 6.0 (5.0; 9) and GDIT – 5.0 (4.0; 9). The indicators of serum lactate (mmol/l) by the time of the skin suture were within the permissible values: RIT – 1.4 (1.1; 1.8), LIT – 1.6 (1.2; 2.1) and GDIT – 1.2 (0.9; 1.5). Analysis of venous saturation data (SvO2): RIT – 75.2 ± 7.2, LIT – 76.5 ± 10.2 and GDIT – 76.5 ± 8.4 (p = 0.616); which indicates an adequate level of oxygen delivery, regardless of the strategy of infusion therapy.

Conclusion. The strategy of infusion therapy for OPCAB, with minimal blood loss, does not affect the course of intraoperative and postoperative periods and the duration of ventilation. Stable hemodynamics is the key to providing adequate anesthesia, regardless of the tactics of infusion therapy.

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****
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About Authors

  • Dzhumber Ya. Khinchagov, Cand. Med. Sci., Anesthesiologist-Intensivist; ORCID
  • Mikhail M. Rybka, Dr. Med. Sci., Head of Department of Anesthesiology and Intensive Care Unit; ORCID
  • Koba V. Mumladze, Anesthesiologist-Intensivist; ORCID
  • Evgeny P. Golubev, Cand. Med. Sci., Senior Research; ORCID
  • Gennady V. Yudin, Cand. Med. Sci., Head of the Department of Resuscitation and Intensive Care; ORCID
  • Yuris Yu. Aidashev, Anesthesiologist-Intensivist; ORCID
  • Igor V. Vorozhka, Anesthesiologist-Intensivist; ORCID

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