Fluid Overload after Coronary Artery Bypass Grafting Surgery Increases the Incidence of Post-Operative Complications

Jean-François Morin, Berguez Mistry, Yves Langlois, Felix Ma, Patrick Chamoun, Christina Holcroft

.

DOI: 10.4236/wjcs.2011.12004                

Abstract

This study is a prospective trial comparing the incidence of post-operative complications to fluid status in patients undergoing coronary artery bypass grafting (CABG) surgery. One hundred and nine subjects undergoing CABG surgery at the Jewish general hospital were recruited over a 5 months period in the year 2006. All of the patients underwent CABG surgery “on pump”. Post operative fluid overload was measured by weight gain. Using logistic regression with complications (major vs. minor only/none) as an outcome and fluid overload as a covariate, the risk of major complications significantly increases for fluid overload ≥5 kg compared to 1 - 5 kg (p < 0.001), while the risk for ≤1 kg is not significantly different from 1 - 5 kg. Also, the risk of major complications significantly (p = 0.012) increases for days with fluid overload ≥5 days in comparison to ≤1 day.

Keywords

Fluid Overload, Complications, Coronary Artery Bypass Grafting

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	R. Bellomo, J. Raman and C. Ronco, “Intensive Care Unit Management of the Critically Ill Patient with Fluid Overload after Open-Heart Surgery,” Cardiology, Vol. 96, No. 3-4, 2001, pp. 169-176. doi:10.1159/000047400
[2]	C. G. Olthof, P. G. Jansen, J. P. De Vries, et al., “Interstitial Fluid Volume during Cardiac Surgery Measured by Means of a Non-Invasive Conductivity Technique,” Acta Anaesthesiol Scand, Vol. 39, 1995, pp. 508-512. doi:10.1111/j.1399-6576.1995.tb04109.x
[3]	M. E. Koller, J. Bert, L. Segadal and R. K. Reed, “Estimation of Total Body Fluid Shifts between Plasma and Interstitium in Man during Extracorporeal Circulation,” Acta Anaesthesiologica Scandinavica, Vol. 36, No. 3, 1992, pp. 255-259. doi:10.1111/j.1399-6576.1992.tb03460.x
[4]	H. J. Geissler and S. J. Allen, “Myocardial Fluid Balance: Pathophysiology and Clinical Implications,” Thorac Cardiovascular Surgery, Vol. 46, Suppl 2, 1998, pp. 242-245. doi:10.1055/s-2007-1013080
[5]	T. Hachenberg, A. Tenling, H. Y. Rothen, S. O. Nystrom, H. Tyden and G. Hedenstierna, “Thoracic Intra Vascular and Extravascular Fluid Volumes in Cardiac Surgical Patients,” Anesthesiology, Vol. 79, 1993, pp. 976-984. doi:10.1097/00000542-199311000-00016
[6]	J. H. Levy and K. A. Tanaka, “Inflammatory Response to Cardiopulmonary Bypass,” The Annals of Thoracic Surgery, Vol. 75, No. 2, 2003, pp. 5715-5720. doi:10.1016/S0003-4975(02)04701-X
[7]	S. Wan, J. L. Leclerc and J. G. Vincent, “Inflammatory Response to Cardiopulmonary Bypass: Mechanisms Involved and Possible Therapeutic Strategies,” Chest, Vol. 112, No. 3, 1997, pp. 676-692. doi:10.1378/chest.112.3.676
[8]	D. E. Chenoweth, S. W. Cooper, T. E. Hugli, R. W. Stewart, E. H. Blackstone and J. W. Kirklin, “Complement Activation during Cardiopulmonary Bypass: Evidence for Generation of C3a and C5a Anaphylatoxins,” The New England Journal of Medicine, Vol. 304, 1981, pp. 497-503. doi:10.1056/NEJM198102263040901
[9]	J. K. Heltne, J. Bert, T. Lund, et al., “Temperature Related Fluid Extravasation during Cardiopulmonary Bypass: An Analysis of Filtration Coefficients and Transcapillary Pressures,” Acta Anaesthesiologica Scandinavica, Vol. 46, No. 1, 2002, pp. 51-56. doi:10.1034/j.1399-6576.2002.460109.x
[10]	Y. Melhorn, K. L. Davis, E. J. Burke, D. Adams, G. A. Laine and S. J. Allen, “Impact of Cardiopulmonary Bypass and Cardioplegic Arrest on Myocardial Lymphatic Function,” American Journal of Physiology, Vol. 268, No. 1, 1995, pp. H178-H183.
[11]	A. Hoeft, H. Korb, Y. Mehlhorn, H. Stephan and H. Sonntag, “Priming of Cardiopulmonary Bypass with Human Albumin or Ringer Lactate: Effect on Colloid Osmotic Pressure and Extra-Vascular Lung Water,” British Journal of Anaesthesia, Vol. 66, No. 1, 1991, pp. 73-80. doi:10.1093/bja/66.1.73
[12]	Y. Mehlhorn, S. J. Allen, D. L. Adams, et al., “Normothermic Continuous Antegrade Cardioplegia Does Not Prevent Myocardial Edema and Cardiac Dysfunction,” Circulation, Vol. 92, 1995, pp. 1940-1946.
[13]	Kirklin/Barratt-Boyes, “Cardiac Surgery,” 3rd Edition, Chapter 5, p. 222.
[14]	B. Brandstrup, et al., “Effects of Intravenous Fluid Restriction on Postoperative Complications: Comparison of Two Perioperative Fluid Regimens,” Annals of Surgery, Vol. 238, No. 5, pp. 641-648. doi:10.1097/01.sla.0000094387.50865.23
[15]	K. Lane, J. Boldt, S. Suttner, et al., “Colloids versus Crystalloids and Tissue Oxygenation Tension in Patients Undergoing Major Abdominal Surgery,” Anesthesia & Analgesia, Vol. 93, 2001, pp. 405-409.
[16]	S. B. Janvrin, G. Davies and R. M. Greenhalgh, “Postoperative Deep Vein Thrombosis Caused by Intravenous Fluids during Surgery,” British Journal of Surgery, Vol. 67, No. 10, 1980, pp. 690-693. doi:10.1002/bjs.1800671004
[17]	D. N. Lobo, K. A. Bostoch, K. R. Neal, et al., “Effect of Salt and Water Balance on Recovery of Gastrointestinal Function after Elective Colonic Resection: A Randomized Controlled Trial,” Lancet, Vol. 359, No. 9320, 2002, pp. 1812-1818. doi:10.1016/S0140-6736(02)08711-1
[18]	S. K. Naik, A. Knight and M. Elliott, “A Prospective Randomized Study of a Modified Technique of Ultrafiltration during Pediatric Open-Heart Surgery,” Circulation, Vol. 84, Suppl 5, 1991, pp. III422-III431.
[19]	S. K. Naik and M. Elliott, “Ultrafiltration and Pediatric Cardiopulmonary Bypass,” Perfusion, Vol. 8, 1993, pp. 101-112. doi:10.1177/026765919300800114
[20]	J. D. Cooper, M. Maeda and E. Lowenstein, “Lung Water Accumulation with Acute Hemodilution in Dogs,” The Journal of Thoracic and Cardiovascular Surgery, Vol. 69, No. 6, 1975, pp. 957-965.
[21]	A. B. Millar, L. Armstrong, J. Van Der Linden, N. Moat, R. Ekroth, J. Westwick, M. Scallan and C. Lincoln, “Cytokine Production and Hemofiltration in Children Undergoing Cardio Pulmonary Bypass,” British Journal of Surgery, Vol. 56, No. 6, 1993, pp. 1499-1502. doi:10.1016/0003-4975(93)90740-9
[22]	R. J. Howard, C. Crain, D. A. Franzini, C. I. Hood and T. E. Hugli, “Effects of Cardiopulmonary Bypass on Pulmonary Leukostasis and Complement Activation,” Archives of Surgery, Vol. 123, No. 12, 1988, pp. 496-501. doi:10.1001/archsurg.1988.01400360066010
[23]	J. Boldt and D. Kline, “Extravascular Lung Water and Hemofiltration during Complicated Cardiac Surgery,” Thoracic and Cardiovascular Surgery, Vol. 35, No. 3, 1987, pp. 161-165. doi:10.1055/s-2007-1020221