PMID- 15162922
OWN - NLM
STAT- MEDLINE
DCOM- 20050310
LR  - 20220310
IS  - 0267-6591 (Print)
IS  - 0267-6591 (Linking)
VI  - 19
IP  - 2
DP  - 2004 Mar
TI  - Highly positive intraoperative fluid balance during cardiac surgery is associated 
      with adverse outcome.
PG  - 85-91
AB  - Hemodilution and increase in capillary permeability occurring with 
      cardiopulmonary bypass (CPB) impose a risk for tissue edema and blood transfusion 
      that may result in an increased complication rate after coronary artery bypass 
      grafting (CABG). Of the 1280 consecutive patients undergoing isolated on-pump 
      CABG, total fluid balance at the end of the operation was less than or equal to 
      500 mL in 1155 (Group 1) and more than 500 mL in 125 (Group 2). During CPB, blood 
      was added to the reservoir only when the hematocrit fell to 17% or less and 
      crystalloid solution only when the pump flow index fell below 2.0 L/min/m2. 
      Anesthetic, surgical, and postoperative management and diagnoses were the same in 
      all patients, and a single surgical and anesthesia team performed all operations. 
      No patient was excluded from the study. RESULTS: Hypertension, diabetes, chronic 
      obstructive pulmonary disease, New York Heart Association (NYHA) Class III-IV, 
      use of angiotensin converting enzyme (ACE) inhibitors, chronic renal failure, and 
      female gender were the significant preoperative risk factors for increased volume 
      replacement during CPB. The groups were similar in body mass index, preoperative 
      hematocrit values, total fluid balance in the intensive care unit (ICU), and 
      total chest tube output. However, red blood cells' transfusion rate, readmission 
      rate to the ICU and length of hospital stay were significantly higher in Group 2 
      patients. Multiple logistic regression revealed that age > 70 years (p < 0.001, 
      Odds Ratio (OR): 2, 95% CI: 1.4-2.8), and total fluid balance > 500 mL at the end 
      of the operation (p < 0.01, OR: 2.2, 95% CI: 1.5-3.2) were the predictors of 
      increased length of stay. For transfusion of red blood cells, age > 70 years (p < 
      0.0001, OR: 2.3, 95% CI: 1.6-3.3), and total fluid balance > 500 mL at the end of 
      the operation (p < 0.001, OR: 2, 95% CI: 1.3-2.9) were the only significant risk 
      factors. This study suggests that intraoperative volume overload increases blood 
      transfusion and length of hospital stay in patients undergoing CABG.
FAU - Toraman, Fevzi
AU  - Toraman F
AD  - Department of Anesthesiology, Acibadem Kadikoy Hospital, Istanbul, Turkey.
FAU - Evrenkaya, Serdar
AU  - Evrenkaya S
FAU - Yuce, Murat
AU  - Yuce M
FAU - Turek, Onur
AU  - Turek O
FAU - Aksoy, Nazan
AU  - Aksoy N
FAU - Karabulut, Hasan
AU  - Karabulut H
FAU - Demirhisar, Onder
AU  - Demirhisar O
FAU - Alhan, Cem
AU  - Alhan C
LA  - eng
PT  - Journal Article
PL  - England
TA  - Perfusion
JT  - Perfusion
JID - 8700166
SB  - IM
MH  - Aged
MH  - *Cardiopulmonary Bypass/adverse effects
MH  - *Coronary Artery Bypass/adverse effects
MH  - Diabetes Mellitus/therapy
MH  - Edema/etiology
MH  - *Erythrocyte Transfusion
MH  - Female
MH  - Hematocrit
MH  - Hemodilution/*adverse effects
MH  - Humans
MH  - Hypertension/therapy
MH  - Intensive Care Units
MH  - *Length of Stay
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/therapy
MH  - Patient Readmission
MH  - Postoperative Complications
MH  - Pulmonary Disease, Chronic Obstructive/therapy
MH  - Risk Factors
MH  - Sex Factors
MH  - *Thoracic Surgery
EDAT- 2004/05/28 05:00
MHDA- 2005/03/11 09:00
CRDT- 2004/05/28 05:00
PHST- 2004/05/28 05:00 [pubmed]
PHST- 2005/03/11 09:00 [medline]
PHST- 2004/05/28 05:00 [entrez]
AID - 10.1191/0267659104pf723oa [doi]
PST - ppublish
SO  - Perfusion. 2004 Mar;19(2):85-91. doi: 10.1191/0267659104pf723oa.