Changes in colloid oncotic pressure during cardiac surgery with different prime fluid strategies

Perfusion, vol. 39, pp. 1371–1379

Abstract

Objective In cardiac surgery, colloid oncotic pressure (COP) is affected by haemodilution that results from composition and volume of prime fluid of cardiopulmonary bypass (CPB). However, the extent to which different priming strategies alter COP is largely unknown. Therefore, we investigated the effect of different priming strategies on COP in on-pump cardiac surgery. Methods Patients ( n = 60) were divided into 3 groups ( n = 20 each), based on the center in which they were operated and the specific prime fluid strategy used in that center during the inclusion period. CPB prime fluids were either gelofusine-, albumin-, or crystalloid based, the latter two with or without retrograde autologous priming. Results In all groups, COP was lowest after weaning from CPB and one hour after CPB. Between groups, COP was lowest with gelofusine prime fluid (16.4, 16.8 mmHg, respectively) compared with crystalloids (MD: -1.9; 95% CI:-3.6, -0.2; p = .02 and MD: -2.4, 95% CI: -4.2, -0.7; p = .002) and albumin (MD: -1.8, 95% CI: -3.5, -0.50; p = .041 and MD: -2.4, 95% CI: -4.1, -0.7; p = .002). In all groups, the decrease in COP one hour after bypass compared to baseline correlated positively with fluid balance at the end of surgery ( p < .001). Conclusions COP significantly decrease during CPB surgery with the largest decrease in COP at the end of surgery, while at the same time fluid balance increases. We suggest that prime fluid strategy should be carefully selected when maintenance of COP during cardiac surgery is desirable.

Authors 8

1. Anne Maria Beukers corresponding

   Amsterdam Cardiovascular Sciences · Amsterdam UMC Location Vrije Universiteit Amsterdam

   Affiliation as printed

   Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands

   Department of Anaesthesiology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

2. Juan de Villiers Hugo Aachen Department of Cardiothoracic Surgery

   Leiden University · Leiden University Medical Center

   Affiliation as printed

   Department of Cardiothoracic Surgery, LUMC, Leiden University, Leiden, The Netherlands

3. Renard Gerhardus Haumann
   Affiliation as printed

   Department of Cardiothoracic Surgery, Thoracic Center Twente, Enschede, The Netherlands

4. J.W. Taco Boltje

   Amsterdam UMC Location University of Amsterdam

   Affiliation as printed

   Department of Cardiothoracic Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands

5. Evy Loan Khiam Ie

   Amsterdam UMC Location Vrije Universiteit Amsterdam

   Affiliation as printed

   Department of Anaesthesiology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

6. Stephan Alexander Loer

   Amsterdam UMC Location Vrije Universiteit Amsterdam

   Affiliation as printed

   Department of Anaesthesiology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

7. Carolien S. E. Bulte

   Amsterdam Cardiovascular Sciences · Amsterdam UMC Location Vrije Universiteit Amsterdam

   Affiliation as printed

   Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands

   Department of Anaesthesiology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

8. Alexander B. A. Vonk

   Amsterdam UMC Location University of Amsterdam

   Affiliation as printed

   Department of Cardiothoracic Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands