Clinical Physiology of Circulation

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


Comparative analysis of the clinical course of intraoperative and early postoperative periods in patients with valvular heart disease, depending on the qualitative and quantitative composition of perioperative infusion therapy

Authors: Yudin G.V., Aydashev Yu.Yu., Rybka M.M., Khinchagov D.Ya., Goncharov A.A., Dibin D.A., Meshchanov B.V.

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

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2021-18-4-291-303

UDC: 616.12-007.42-089

Link: Clinical Physiology of Blood Circulaiton. 2021; 4 (18): 291-303

Quote as: Yudin G.V., Aydashev Yu.Yu., Rybka M.M., Khinchagov D.Ya., Goncharov A.A., Dibin D.A., Meshchanov B.V. Comparative analysis of the clinical course of intraoperative and early postoperative periods in patients with valvular heart disease, depending on the qualitative and quantitative composition of perioperative infusion therapy. Clinical Physiology of Circulation. 2021; 18 (4): 291–303 (in Russ.). DOI: 10.24022/1814-6910-2021-18-4-291-303

Received / Accepted:  08.10.2021 / 23.10.2021

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Abstract

Objective. Comparative analysis of the clinical course of intraoperative and early postoperative periods in patients operated on heart valves, depending on the quantitative and qualitative composition of perioperative infusion therapy.

Material and methods. A prospective randomized trial involving 93 patients operated on heart valves, divided into groups: restrictive (n = 32), and liberal (n = 31) infusion (RI, LI), and the albumin group (ALB, n = 30). The implementation of one or another infusion therapy tactic was carried out in the prebypass period on the basis of a balanced crystalloid solution sterofundin of 3 ml/kg/h in the RI group, 20 ml/kg/h in LI, and 5 ml/kg/h in combination with a 5% albumin solution of 5 ml/kg/h in ALB in the prebypass period.

Results. With comparable oxygen delivery in the postbypass period and after the operation, liberal and albumin infusion led to a decrease in its consumption from 93 ± 53 ml/min/m2 in the RI group to 72 ± 26 ml/min/m2 in LI (p = 0.01), and 86 ± 32 ml/min/m2 in ALB (p = 0.03) in combination with an increase in serum lactate concentration from 2.1 ± 1.3 mmol/l in the RI group to 2.7 ± 2.0 mmol/l in LI (p = 0.03) and to 2.3 ± 1.2 mmol/l in ALB (p = 0.04), and maintaining a similar difference after the end of the operation with an equal level of glycemia. In the ALB group, the development of impaired oxygenating lung function of moderate severity (100 < PaO2/FiO2 < 200) was noted, 9% versus 0% in RI and LI (p = 0.001). The duration of the ventilator was higher in the groups of LI – 18 (15; 22) hours (p = 0.01), and ALB – 17 (12; 22) hours (p = 0.03) compared with RI – 14 (10; 19) hours.

Conclusion. In comparison with restrictive infusion, the implementation of liberal and albumin tactics is accompanied by a decrease in tissue oxygen consumption with an increase in lactate production and an increase in the duration of ventilation in patients operated on heart valves.

References

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  1. Romagnoli S., Rizza A., Ricci Z. Fluid status assessment and management during the perioperative phase in adult cardiac surgery patients. J. Cardiothorac. Vasc. Anesth. 2016; 30 (4): 1076–84. DOI: 10.1053/j.jvca. 2015.11.008
  2. Gruartmoner G., Mesquida J., Ince C. Fluid therapy and the hypovolemic microcirculation. Curr. Opin. Crit. Care. 2015; 21 (4): 276–84. DOI: 10.1097/MCC.0000000000000220
  3. Harris T., Coats T.J., Elwan M.H. Fluid therapy in the emergency department: an expert practice review. Emerg. Med. J. 2018; 35 (8): 511–5. DOI: 10.1136/emermed-2017-207245
  4. Arulkumaran N., Corredor C., Hamilton M.A., Ball J., Grounds R.M., Rhodes A., Cecconi M. Cardiac complications associated with goal-directed therapy in high-risk surgical patients: a meta-analysis. Br. J. Anaesth. 2014; 112 (4): 648–59. DOI: 10.1093/bja/aet466
  5. Gottin L., Martini A., Menestrina N., Schweiger V., Malleo G., Donadello K., Polati E. Perioperative fluid administration in pancreatic surgery: a comparison of three regimens. J. Gastrointest. Surg. 2020; 24 (3): 569–77. DOI: 10.1007/s11605-019-04166-4
  6. Pang Q., Liu H., Chen B., Jiang Y. Restrictive and liberal fluid administration in major abdominal surgery. Saudi Med. J. 2017; 38 (2): 123–31. DOI: 10.15537/smj.2017.2.15077
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  9. Parke R., Bihari S., Dixon D.-L., Gilder E., Cavallaro E., McGuinness S. et al. Fluid resuscitation associated with elevated angiopoietin-2 and length of mechanical ventilation after cardiac surgery. Crit. Care Resusc. 2018; 20 (3): 198–208. PMID: 30153782.
  10. Mehta R.L., Kellum J.A., Shah S.V., Molitoris B.A., Ronco C., Warnock D.G. et al. Acute kidney injury network: report of an initiative to improve outcomes in acute kidney injury. Crit. Care. 2007; 11 (2): R31. DOI: 10.1186/cc5713
  11. Ranieri V.M., Rubenfeld G.D., Thompson B.T., Ferguson N.D., Caldwell E., Fan E. et al. ARDS definition task force. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012; 307 (23): 2526–33. DOI: 10.1001/jama.2012.5669
  12. Strunden M.S., Heckel K., Goetz A.E., Reuter D.A. Perioperative fluid and volume management: physiological basis, tools and strategies. Ann. Intensive Care. 2011; 1 (1): 2. DOI: 10.1186/2110-5820-1-2
  13. Cutuli S.L., Bitker L., Osawa E.A., O'Brien Z., Canet E., Yanase F. et al. Haemodynamic effect of a 20% albumin fluid bolus in post-cardiac surgery patients. Crit. Care Resusc. 2020; 22 (1): 15–25. PMID: 32102639.
  14. Li C., Wang H., Liu N., Jia M., Zhang H., Xi X. et al. Acute kidney injury trial (BAKIT) workgroup. Early negative fluid balance is associated with lower mortality after cardiovascular surgery. Perfusion. 2018; 33 (8): 630–7. DOI: 10.1177/0267659118780103
  15. Wigmore G.J., Anstey J.R., John A.St., Greaney J., Morales-Codina M., Presneill J.J. et al. 20% human albumin solution fluid bolus administration therapy in patients after cardiac surgery (the HAS FLAIR Study). J. Cardiothorac. Vasc. Anesth. 2019; 33 (11): 2920–7. DOI: 10.1053/j.jvca.2019.03.049
  16. Frenette A.J., Bouchard J., Bernier P., Charbonneau A., Nguyen L.T., Rioux J-P. et al. Albumin administration is associated with acute kidney injury in cardiac surgery: a propensity score analysis. Crit. Care. 2014; 18 (6): 602. DOI: 10.1186/s13054-014-0602-1

About Authors

  • Gennadiy V. Yudin, Cand. Med. Sci., Anesthesiologist-Intensivist; ORCID
  • Yuris Yu. Aydashev, Anesthesiologist-Intensivist; ORCID
  • Mikhail M. Rybka, Dr. Med. Sci., Head of Department of Anesthesiology and Intensive Care Unit; ORCID
  • Dzhumber Ya. Khinchagov, Cand. Med. Sci., Anesthesiologist-Intensivist; ORCID
  • Andrey A. Goncharov, Anesthesiologist-Intensivist; ORCID
  • Denis A. Dibin, Anesthesiologist-Intensivist; ORCID
  • Bair V. Meshchanov, Anesthesiologist-Intensivist; ORCID

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