albumin additionally . Most perfusionists only use crystalloids for priming whereas approximately 33 % chose 25 % protein plus crystalloid for priming . It was concluded that , in the US , the real-world resuscitation model differs depending on patient characteristics and the clinical situation . The advantages of colloids include less oedema , good volume expansion , faster effects , and a lesser impact on respiratory function . 4
solution or Plasmalyte ) is a better option as it is low in chloride and associated with less AKI . 10
Fluid resuscitation during the perioperative period The 2017 American Cardiac Surgery Fluid Resuscitation Questionnaire conducted a crosssection online survey for 124 cardiovascular clinicians ( anaesthesiologists , perfusionists and surgeons ). 11 From this , the volume indicators used most commonly were determined to be blood pressure , urine volume , CO , CVP and heart rate . Crystalloids are the preferred resuscitation fluids for cases without bleeding whereas 5 % albumin is preferred with bleeding . For volume expansion during ECMO or VAD , 5 % albumin plus crystalloids is preferred . Surgeons tend to choose starch as the fluid for non-bleeding patients , with 25 %
Evaluation of fluid treatment after cardiac surgery After cardiac surgery , it is necessary to determine volume status ( DO2 ). Oxygen delivery is the focus which demands essential amount of fluids . Too much fluid is harmful after cardiac surgery and excessive fluid load can worsen a patient ’ s prognosis ( for example , through development of heart failure ). Caution should be exercised once the volume exceeds 2 – 3l , especially after the patient has completely warmed . Pulmonary oedema , blood dilution , and increased perioperative blood transfusion , ALI / ARDS , impaired intestinal absorption , renal excretion , increased abdominal pressure , and volume determination require comprehensive judgment and assessment . Volume monitoring indicators are helpful ; in particular , the role of ultrasound in volume assessment . The evaluation of fluid therapy after cardiac surgery also has special considerations . For example , patients with severe myocardial hypertrophy need higher filling pressure . Long aorta clamping time reduces ventricular compliance and requires higher pressure . Ongoing fluid flow requires rapid and timely assessment for other factors that cause haemodynamic instability such as : bleeding , tamponade , tonic pneumothorax , valvular dysfunction , myocardial ischaemia and heart failure . Echocardiography is clinically useful , especially in situations of unclear haemodynamics . A small transoesophageal echocardiography probe may stay in place for 72 hours and is useful for guiding resuscitation . PiCCO monitoring is restricted due to thoracotomy and limited accuracy and poor accuracy . The meta-analysis showed that PPV and SVV had poor predictive value , being heterogeneous compared to other indicators . Preload is more important for cardiac insufficiency .
Conclusions Albumin is used in the perioperative management of cardiac surgery , and its use is associated with improvements in plasma osmotic pressure and the expansion effects . It can better maintain tissue perfusion , has anti-inflammatory effects , improves vascular endothelial integrity , and affects coagulation function . It is small molecule and does not cause clinical oedema , thereby helping to achieve the goal of improving the success rate of surgery and conferring long-term survival benefits . 12
References 1 Finfer S et al . A comparison of albumin and saline for fluid resuscitation in the intensive care unit . N Engl J Med 2004 ; 350 ( 22 ): 2247 – 56 . 2 Navickis RJ , Haynes GR , Wilkes MM . Effect of hydroxyethyl starch on bleeding after cardiopulmonary bypass : a meta-analysis of randomized trials . J Thorac Cardiovasc Surg 2012 ; 144:223 – 30 . 3 Bayer O et al . Perioperative fluid therapy with tetrastarch |
and gelatin in cardiac surgery - a prospective sequential analysis . Crit Care Med 2013 ; 41 ( 11 ): 2532 – 42 . 4 Magder S et al ; Canadian Critical Care Trials Group . Fluids after cardiac surgery : a pilot study of the use of colloids versus crystalloids . Crit Care Med 2010 ; 38 ( 11 ): 2117 – 24 . 5 Moret E et al . Albumin - Beyond fluid replacement in cardiopulmonary bypass surgery : Why , how , and when ? Semin Cardiothorac Vasc Anesth |
2014 ; 18 ( 3 ): 252 – 9 . 6 Wilkes MM , Navickis RJ , Sibbald WJ . Albumin versus hydroxyethyl starch in cardiopulmonary bypass surgery : a meta-analysis of postoperative bleeding . Ann Thorac Surg 2001 ; 72 ( 2 ): 527-33 ; discussion 534 . 7 Jacob M et al . Albumin augmentation improves condition of guinea pig hearts after 4 hr of cold ischemia . Transplantation 2009 ; 87 ( 7 ): 956 – 65 . 8 Russell JA , Navickis RJ , |
Wilkes MM . Albumin versus crystalloid for pump priming in cardiac surgery : meta-analysis of controlled trials . J Cardiothorac Vasc Anesth 2004 ; 18 ( 4 ): 429 – 37 . 9 Sedrakyan A et al . Volume expansion with albumin decreases mortality after coronary artery bypass graft surgery . Chest 2003 ; 123 ( 6 ): 1853 – 7 . 10 Barea-Mendoza J , Chico- Fernández M , Montejo-González JC . Balanced crystalloids versus saline in critically ill adults . N |
Engl J Med 2018 ; 378 ( 20 ): 1950 – 1 . 11 Aronson S , Nisbet P , Bunke M . Fluid resuscitation practices in cardiac surgery patients in the USA : a survey of health care providers . Perioper Med ( Lond ) 2017 ; 19 ; 6:15 . 12 Zhang H Clinical application of human serum albumin in perioperative period of cardiac surgery . 2019 ; 10 ; 37:41 [ article in Chinese ]. |
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