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Related Experiment Videos

Optimal postoperative volume loading.

R D Weisel, R J Burns, R J Baird

    The Journal of Thoracic and Cardiovascular Surgery
    |April 1, 1983
    PubMed
    Summary
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    Maintaining optimal ventricular preload after coronary bypass surgery is crucial for patient recovery. An ideal left atrial pressure (LAP) range of 5-12 mm Hg ensures adequate cardiac function and lactate extraction, preventing metabolic abnormalities.

    Area of Science:

    • Cardiology
    • Cardiac Surgery
    • Critical Care Medicine

    Background:

    • Intravenous infusions are vital for maintaining ventricular preload post-coronary bypass surgery.
    • Volume loading aims to stabilize ventricular function and metabolism during early myocardial recovery.
    • Preventing progressive ischemic injury is a key goal in the immediate postoperative phase.

    Purpose of the Study:

    • To determine the optimal preload for both myocardial metabolism and performance after coronary bypass.
    • To investigate the effects of different left atrial pressure (LAP) levels on cardiac function and metabolism.

    Main Methods:

    • Thirty-seven patients undergoing elective coronary bypass surgery were studied.
    • Volume loading with whole plasma was performed, comparing responses at low LAP (VLA) and higher LAP (VLB).

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  • Cardiac index, stroke work index, ejection fraction, and myocardial lactate extraction/production were measured.

    • Main Results:

    • Both low and high volume loading increased cardiac index, stroke work index, and end-diastolic volume index (EDVI).
    • Ejection fraction decreased with volume loading, potentially due to increased wall tension.
    • Myocardial lactate extraction improved with VLA but resulted in lactate production with VLB.

    Conclusions:

    • An optimal LAP range of 5-12 mm Hg, corresponding to an EDVI of 30-80 ml/m2, supports adequate cardiac function and lactate extraction post-surgery.
    • Preload levels outside this range did not enhance function and led to abnormal myocardial metabolism.
    • Myocardial performance and compliance were not significantly altered in the early postoperative period.