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Conventional hemofiltration during cardiopulmonary bypass increases the serum lactate level in adult cardiac surgery


1 Department of Cardiac anesthesia, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia; Department of Anesthesia, Cairo University, Giza, Egypt
2 Department of Anesthesia, Cairo University, Giza, Egypt, Egypt
3 Department of Cardiac anesthesia, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
4 Department of Intensive Care, Cairo University, Giza, Egypt

Correspondence Address:
Rabie Soliman
Department of Cardiac anesthesia, Prince Sultan Cardiac Center, Riyadh

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.173019

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Year : 2016  |  Volume : 19  |  Issue : 1  |  Page : 45-51

 

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Objective: To evaluate the effect of hemofiltration during cardiopulmonary bypass on lactate level in adult patients who underwent cardiac surgery. Design: An observational study. Setting: Prince Sultan cardiac center, Riyadh, Saudi Arabia. Participants: The study included 283 patients classified into two groups: Hemofiltration group (n=138), hemofiltration was done during CPB. Control group (n = 145), patients without hemofiltration. Interventions: Hemofiltration during cardiopulmonary bypass. Measurements and Main Results: Monitors included hematocrit, lactate levels, mixed venous oxygen saturation, amount of fluid removal during hemofiltration and urine output. The lactate elevated in group H than group C (P < 0.05), and the PH showed metabolic acidosis in group H (P < 0.05). The mixed venous oxygen saturation decreased in group H than group C (P < 0.05). The number of transfused packed red blood cells was lower in group H than group C (P < 0.05). The hematocrit was higher in group H than group C (P < 0.05). The urine output was lower in group H than group C (P < 0.05). Conclusions: Hemofiltration during cardiopulmonary bypass leads to hemoconcentration, elevated lactate level and increased inotropic support. There are some recommendations for hemofiltration: First; Hemofiltration should be limited for patients with impaired renal function, positive fluid balance, reduced response to diuretics or prolonged bypass time more than 2 hours. Second; Minimal amount of fluids should be administered to maintain adequate cardiac output and reduction of priming volumes is preferable to maintain controlled hemodilution. Third; it should be done before weaning of or after cardiopulmonary bypass and not during the whole time of cardiopulmonary bypass.






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1 Department of Cardiac anesthesia, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia; Department of Anesthesia, Cairo University, Giza, Egypt
2 Department of Anesthesia, Cairo University, Giza, Egypt, Egypt
3 Department of Cardiac anesthesia, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
4 Department of Intensive Care, Cairo University, Giza, Egypt

Correspondence Address:
Rabie Soliman
Department of Cardiac anesthesia, Prince Sultan Cardiac Center, Riyadh

Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.173019

Rights and Permissions

Objective: To evaluate the effect of hemofiltration during cardiopulmonary bypass on lactate level in adult patients who underwent cardiac surgery. Design: An observational study. Setting: Prince Sultan cardiac center, Riyadh, Saudi Arabia. Participants: The study included 283 patients classified into two groups: Hemofiltration group (n=138), hemofiltration was done during CPB. Control group (n = 145), patients without hemofiltration. Interventions: Hemofiltration during cardiopulmonary bypass. Measurements and Main Results: Monitors included hematocrit, lactate levels, mixed venous oxygen saturation, amount of fluid removal during hemofiltration and urine output. The lactate elevated in group H than group C (P < 0.05), and the PH showed metabolic acidosis in group H (P < 0.05). The mixed venous oxygen saturation decreased in group H than group C (P < 0.05). The number of transfused packed red blood cells was lower in group H than group C (P < 0.05). The hematocrit was higher in group H than group C (P < 0.05). The urine output was lower in group H than group C (P < 0.05). Conclusions: Hemofiltration during cardiopulmonary bypass leads to hemoconcentration, elevated lactate level and increased inotropic support. There are some recommendations for hemofiltration: First; Hemofiltration should be limited for patients with impaired renal function, positive fluid balance, reduced response to diuretics or prolonged bypass time more than 2 hours. Second; Minimal amount of fluids should be administered to maintain adequate cardiac output and reduction of priming volumes is preferable to maintain controlled hemodilution. Third; it should be done before weaning of or after cardiopulmonary bypass and not during the whole time of cardiopulmonary bypass.






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