Related Experiment Videos
The importance of colloid osmotic pressure during open heart surgery in infants
Insights
Maintaining colloid osmotic pressure during cardiopulmonary bypass with colloid hemodilution prime significantly reduced fluid accumulation in infants undergoing heart surgery. This improved patient care and reduced intensive care unit stays.
Area of Science:
- Pediatric Cardiac Surgery
- Cardiovascular Physiology
- Intensive Care Medicine
Background:
- Infants with transposition of the great arteries and total anomalous pulmonary venous return often require complex intracardiac repair.
- Hypothermic circulatory arrest during cardiopulmonary bypass (CPB) is associated with fluid balance derangements, a major postoperative complication.
- Colloid osmotic pressure (COP) is critical for regulating fluid balance.
Purpose of the Study:
- To evaluate the impact of maintaining colloid osmotic pressure (COP) during CPB on fluid balance in infants undergoing intracardiac repair.
- To assess the effect of colloid hemodilution prime on postoperative outcomes, including fluid accumulation, intensive care unit (ICU) stay, and mortality.
Main Methods:
- Retrospective analysis of 55 infants undergoing intracardiac repair for transposition of the great arteries and total anomalous pulmonary venous return (1975-1983).
- Comparison of two groups: Group A (lactated Ringer's hemodilution) and Group B (colloid hemodilution prime with whole blood and plasma).
- Monitoring of fluid balance, COP, total protein concentration, ICU stay, and mortality rates.
Main Results:
- Group B (colloid prime) demonstrated significantly reduced fluid balance at the end of CPB (+81.1 ml/kg) compared to Group A (+299.5 ml/kg) (p<0.01).
- Survivors in Group B had a halved ICU stay (10.9 days) compared to Group A (20.6 days) (p<0.05).
- Mortality rate was lower in Group B (23%) compared to Group A (42%).
Conclusions:
- Maintaining adequate colloid osmotic pressure levels during cardiopulmonary bypass using colloid hemodilution prime effectively reduces postoperative fluid accumulation in infants.
- This strategy simplifies patient care and improves outcomes following infant open-heart surgery.
- Colloid hemodilution prime is a beneficial adjunct in pediatric cardiac surgery involving hypothermic circulatory arrest.
Abstract:
Fifty-five infants with transposition of the great arteries and with total anomalous pulmonary venous return underwent intracardiac repair under combined surface/perfusion hypothermia and total circulatory arrest in 1975 to 1983. Although cardiopulmonary bypass (CPB) time is limited when hypothermic circulatory arrest is employed, fluid balance derangement is one of the major postoperative complications. Fluid balance at the end of CPB averaged +299.5 ml (+63.4 ml/kg) when hemodilution with lactated Ringer's was utilized (Group A). Since colloid osmotic pressure (COP) plays an important role in regulating fluid balance, colloid hemodilution prime (whole blood and plasma) was employed in the last 3 years (Group B). COP and total protein concentration during CPB with colloid prime were maintained at around 19 mmHg and 5 g/100 ml, respectively. In Group B, fluid balance at the end of CPB averaged +81.1 ml (+16.3 ml/kg) and was significantly less than in Group A (p less than 0.01). The ICU stay period for survivors in Group B (average 10.9 days) was reduced to half the period in Group A (average 20.6 days) (p less than 0.05). The mortality rate in Group A was 42%, whereas 23% in Group B. It was concluded that well-maintained COP levels during CPB with colloid hemodilution prime reduced fluid accumulation in the body and made patient care easier following open heart surgery in infants.