The hemodynamic effects of warm versus room-temperature crystalloid fluid bolus therapy in post-cardiac surgery patients

Perfusion ◽  
2021 ◽  
pp. 026765912110122
Author(s):  
Laurent Bitker ◽  
Salvatore L Cutuli ◽  
Fumitaka Yanase ◽  
Anthony Wilson ◽  
Eduardo A Osawa ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Core Temperature ◽  
Room Temperature ◽  
Fluid Temperature ◽  
Hemodynamic Effects ◽  
Fluid Bolus ◽  
Crystalloid Fluid ◽  
Before And After ◽  
Before And After Study ◽  
Post Cardiac Surgery

Introduction: The contribution of fluid temperature to the effect of crystalloid fluid bolus therapy (FBT) in post-cardiac surgery patients is unknown. We evaluated the hemodynamic effects of FBT with fluid warmed to 40°C (warm FBT) versus room-temperature fluid. Methods: In this single centre prospective before-and-after study, we evaluated the effects of 500 ml of warm versus room-temperature compound sodium lactate administered over <30 minutes, in 50 cardiac surgery patients admitted to ICU. We recorded hemodynamics continuous before and for 30 minutes after the first FBT. We defined CI responsiveness (CI-R) as an CI increase >15% of baseline immediately after FBT and effect dissipation if the CI returned to <5% of baseline and MAP responsiveness as >10% increase and dissipation as return to <3 mmHg of baseline. Results: Hypotension (56%) and low CI (40%) typically triggered FBT. Temperature decreased >0.3°C in 13 (52%) patients after room-temperature FBT versus 0 (0%) after warm FBT (p < 0.01). CI and MAP responsiveness was similar (16 [64%] versus 11 [44%], p = 0.15 and 15 [60%] versus 17 [68%], p = 0.77, respectively). Among CI responders, CI increased more with room-temperature FBT (+0.6 [IQR, 0.5–1.1] versus +0.5 [IQR, 0.4–0.6] L/min/m2, p = 0.01). However, dissipation was more common after room-temperature versus warm FBT (9/16 [56%] versus 1/11 [9%], p = 0.02). Conclusion: In postoperative cardiac surgery patients, warm FBT preserved core temperature and induced smaller but more sustained CI increases among responders. Fluid temperature appears to impact both core temperature and the duration of CI response.

scholarly journals Rapid 500 mL albumin bolus versus rapid 200 mL bolus followed by slower continuous infusion in post-cardiac surgery patients: a pilot before-and-after study

2021 ◽  
Vol 23 (3) ◽  
pp. 320-328
Author(s):  
Fumitaka Yanase ◽  
◽  
Thummaporn Naorungroj ◽  
Salvatore L Cutuli ◽  
Glenn M Eastwood ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Venous Pressure ◽  
Single Centre ◽  
Central Venous ◽  
Fluid Bolus ◽  
Mechanically Ventilated ◽  
Before And After ◽  
Before And After Study ◽  
Trial Setting ◽  
Post Cardiac Surgery

OBJECTIVE: To evaluate the haemodynamic effects of rapid fluid bolus therapy (FBT) (500 mL of 4% albumin over several minutes) versus combined FBT (rapid 200 mL FBT followed by a 300 mL infusion over 30 minutes). DESIGN: Single centre, prospective, before-and-after trial. SETTING: A tertiary intensive care unit in Australia. PARTICIPANTS: Fifty mechanically ventilated post-cardiac surgery patients. INTERVENTIONS: Rapid 4% albumin FBT versus combined FBT. MAIN OUTCOME MEASURES: We recorded haemodynamic parameters from before FBT to 30 minutes after FBT. A mean arterial pressure (MAP) response was defined by a MAP increase > 10%, and a cardiac index (CI) response was defined by a CI increase > 15%. RESULTS: Immediately after rapid FBT versus combined FBT, there was a CI response in 13 patients (52%) compared with five patients (20%) respectively (P = 0.038), and a MAP response in 11 patients (44%) in each group. However, from FBT administration to 30 minutes, there was a time and group interaction such that MAP was higher in the rapid FBT group (P = 0.003), as was the case for central venous pressure (P = 0.002) and mean pulmonary artery pressure (P < 0.001). Body temperature fell immediately and was lower with rapid FBT but became warmer than with combined FBT later (P < 0.001). At 30 minutes, a MAP response was seen in ten patients (40%) compared with nine patients (36%) (P < 0.99) and a CI response was present in eight patients (32%) compared with 11 patients (44%) (P = 0.56) in the rapid versus combined FBT groups respectively. CONCLUSION: Rapid FBT was superior to combined FBT in terms of mean MAP levels and immediate CI response. However, the number of MAP responders or CI responders was similar at 30 minutes.

A comparison of the hemodynamic effects of fluid bolus therapy with crystalloids vs. 4% albumin and vs. 20% albumin in patients after cardiac surgery

Heart & Lung ◽  
2021 ◽  
Vol 50 (6) ◽  
pp. 870-876
Author(s):  
Fumitaka Yanase ◽  
Salvatore L Cutuli ◽  
Thummaporn Naorungroj ◽  
Laurent Bitker ◽  
Anthony Wilson ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Hemodynamic Effects ◽  
Fluid Bolus

Haemodynamic effect of a 20% albumin fluid bolus in post-cardiac surgery patients

2020 ◽  
Vol 22 (1) ◽  
pp. 15-25
Author(s):  
Salvatore L Cutuli ◽  
◽  
Laurent Bitker ◽  
Eduardo A Osawa ◽  
Zachary O’Brien ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiovascular Effect ◽  
Prospective Observational Study ◽  
Haemodynamic Effect ◽  
Clinical Decision ◽  
Bolus Administration ◽  
Fluid Bolus ◽  
Mechanically Ventilated ◽  
Study Setting ◽  
Post Cardiac Surgery

Objective: To study the cardiovascular effect over 30 minutes following the end of fluid bolus therapy (FBT) with 20% albumin in patients after cardiac surgery. Design: Prospective observational study. Setting: Intensive care unit of a tertiary university-affiliated hospital. Participants: Twenty post-cardiac surgery mechanically ventilated patients with a clinical decision to administer FBT. Intervention: FBT with a 100 mL bolus of 20% albumin. Main outcome measures: Cardiac index (CI) response was defined by a  15% increase, while mean arterial pressure (MAP) response was defined by a  10% increase. Results: The most common indication for FBT was hypotension (40%). Median duration of infusion was 7 minutes (interquartile range [IQR], 3–9 min). At the end of FBT, five patients (25%) showed a CI response, which increased to almost half in the following 30 minutes and dissipated in one patient. MAP response occurred in 11 patients (55%) and dissipated in five patients (45%) by a median of 6 minutes (IQR, 6–10 min). CI and MAP responses coexisted in four patients (20%). An intrabolus MAP response occurred in 17 patients (85%) but dissipated in 11 patients (65%) within a median of 7 minutes (IQR, 2–11 min). On regression analysis, faster fluid bolus administration predicted MAP increase at the end of the bolus. Conclusion: In post-cardiac surgery patients, CI response to 20% albumin FBT was not congruous with MAP response over 30 minutes. Although hypotension was the main indication for FBT and a MAP response occurred in most of patients, such response was maximal during the bolus, dissipated in a few minutes, and was dissociated from the CI response.

Comparison of Levosimendan and Milrinone for ECLS Weaning in Patients After Cardiac Surgery—A Retrospective Before-and-After Study

2018 ◽  
Vol 32 (5) ◽  
pp. 2112-2119 ◽  
Author(s):  
Annina Jacky ◽  
Alain Rudiger ◽  
Bernard Krüger ◽  
Markus J. Wilhelm ◽  
Sebastian Paal ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Before And After ◽  
Before And After Study

Neurone-specific enolase and Sangtec 100 assays during cardiac surgery: part II - must samples be spun within 30 min?

Perfusion ◽  
1997 ◽  
Vol 12 (3) ◽  
pp. 167-169 ◽  
Author(s):  
S Sapsed-Byrne ◽  
F Gao ◽  
D N F Harris
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Plasma Levels ◽  
Room Temperature ◽  
Cerebral Damage ◽  
Blood Samples ◽  
Before And After ◽  
S 100

Sangtec 100 (S-100) (Sangtec Medical, Sweden) and neurone-specific enolase (NSE) assays are showing promise in the assessment of cerebral damage following cardiopulmonary bypass (CBP). The manufacturer’s instructions state, however, that samples must be spun and frozen within 30 min, which is inconvenient for serial studies. We, therefore, investigated whether storing blood samples at room temperature (RT) or 4°C for up to 48 h affected the measured levels. Blood samples were taken before and after CBP in six patients and stored for 15 min, 4, 8, 24 or 48 h at RT or 4°C. S-100 and NSE levels did not alter in either ‘before surgery’ or CPB samples when stored for up to 48 h at 4°C. There was a small, nonsignificant rise when stored at RT. Samples may, therefore, be collected throughout long operations or stored overnight without affecting NSE or S-100 plasma levels.

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