Fluid resuscitation after cardiac surgery
Sound management of perioperative fluid resuscitation in cardiac surgery helps to reduce postoperative bleeding , prevent fluid overload , kidney impairment and systemic inflammation
Perioperative management of the patient undergoing cardiac surgery is a complex procedure and intraoperative fluid therapy is an integral part of anesthesia management to prevent damage to organs and ensure an adequate supply of fluid and maintenance of volume . 1 Particular challenges in this patient group include the complexitiy of the surgical intervention and the impact on extracorporeal circulation on pathophysiology . 1 Fluid therapy should lead to stabilization of both the micro- and macro-circulation , and circulation is affected by different fluids . 1
Choice of perioperative fluid During cardiac surgery , large fluid transfers , priming of the cardiopulmonary bypass ( CPB ) circuit , blood and blood product transfusions , as well as long surgery time , invariably lead to fluid overload . Nevertheless , despite receiving large amounts of fluid during surgery , CPB patients often experience capillary leakage , leading to edema and intravascualr volume depletion . 1 Additionally , because the CPB extracorporeal circulatory system is non-physiological , the coagulation system becomes activated once blood makes contact with the surface of the system . This results in a considerable hemostatic disruption both during and after surgery , increasing the risk of peri-operative thrombosis , hemorrhage 2 and renal impairment . 3 Despite activation of the coagulation system , the level of coagulation factors are actually reduced during CPB due to hemodilution , and while excessive bleeding can occur after the procedure , this has been found to be low , at around 11 % in a clinical trial 4 with only 5 – 7 % of patients experiencing blood loss in excess of 2l within the initial 24-hour postoperative period . 5 However , a further concern with CPB is the potential for capillary leak syndrome which increases the extracellular fluid volume and reduces the blood circulating volume . For example , in one study of 15 patients undergoing CPB , there was a reduction
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