Efeitos da ultrafiltração modificada na função pulmonar e necessidade de hemotransfusão em pacientes submetidos à revascularização do miocárdio

Abstract

Efeitos da ultrafiltração modificada na função pulmonar e necessidade de hemotransfusão em pacientes submetidos à revascularização do miocárdioThe effects of modified ultrafiltration on pulmonary function and transfusion requirements in patients undergoing coronary artery bypass graft surgery Abstract Objective: The inflammatory response after cardiac surgery increases vascular permeability leading to higher mortality and morbidity in the post operative time. The modified ultrafiltration (MUF) has shown benefits in respiratory and hemodynamic function in pediatric patients. This approach in adults is not well established yet. We hypothesize that modified ultrafiltration may improve respiratory, hemodynamic and coagulation function in adults after cardiac surgeries.Methods: A prospective randomized study was carried out with 37 patients who underwent coronary artery bypass graft surgery (CABG) were randomized either to MUF (n=20) at the end of bypass or to control (no MUF) (n=17). The anesthesia and ICU team were blinded for the group selection. The MUF were carried out for 15 minutes after the end of bypass. The patients' data were taken at beginning of anesthesia, ending of bypass, ending MUF, 24 hours, and 48 hours after surgery. For clinical outcome the pulmonary, hemodynamic and coagulation function were evaluated.Results: We observed lower drain loss in the MUF group compared to control group after 48 hours (598±123 vs. 848±455 ml; p=0.04) and required less red blood cell unit transfusions compared to control group (0.6 ± 0.6 vs.1.6±1.1 units/patient; P=0.03). The MUF group showed lower airway resistance (9.3±0.4 vs. 12.1±0.8 cmH2O.L-1s-1; P=0.04). There were no deaths in both groups.Conclusion: The MUF reduces post operatory bleeding and red blood cells unit transfusion, but with no differences on clinical outcome were observed. The routinely MUF employment was not associated with hemodynamic instability. Descriptors 60TORINA, AG ET AL -The effects of modified ultrafiltration on pulmonary function and transfusion requirements in patients undergoing coronary artery bypass graft surgery Bras Cir Cardiovasc 2010; 25(1): 59-65 transfusion and postoperative drain loss inelective coronary artery bypass graft surgery. Rev METHODS Patient selectionAfter approval of the Ethics in Research Committee of our institution and registration in the National Ethics in Research System the patients were included in a prospective, randomized and blind study to the anesthesia and ICU team. The included patients presented the following characteristics: male/female, coronary artery bypass graft surgery, ejection fraction higher than 40%, which was estimated by cardiac catheterism in anterior right oblique projection, elective surgery, diabetics or nondiabetics. The criteria of exclusion were: presence of any kind of neoplasia, depressed renal function that was defined as creatinine clearance lower than 45 ml/minute for males and lower than 40 ml/minute for females. Surgical procedureThe patients were submitted to inhalant and...

Ultrafiltration in cardiac surgery: Results of a systematic review and meta-analysis

“…An additional 55 articles were excluded on the following basis: 1) no data on the primary outcome of interest, 2) transfusion outcome with incomparable units, 3) pediatric patient population, 4) intervention other than MUF or CUF, 5) meta-analysis or systematic review, 6) combined use of MUF and CUF in study group, and 7) lack of nonultrafiltration control group. Nine studies 3,5,10,[13][14][15][16][17][18][19] (n = 47,985 patients) were included in the final analysis. There were 7 RCTs (n = 928) 3,10,13-17 and 2 observational studies (n = 47,007) 5,18 included in the analysis.…”

“…Of note, 6 included studies did not report mean weight or body surface area of study groups. 5,10,13,[15][16][17] Supplemental Figure 2 illustrates the Cochrane Risk of Bias 2.0 reporting for all included RCT studies. Two of 7 studies demonstrated an overall high risk of bias due to randomization process and deviations from intended interventions.…”

“…After exclusion of 2 trials that exhibited randomization bias and deviations due to intended interventions based upon the Cochrane Collaboration risk of bias tool 2.0, MUF was associated with a statistically significant reduction in the mean allogeneic red cells transfused (n = 5; MD -0.97; 95% CI, À1.23 to À0.71; p < 0.0001); p for heterogeneity = 0.18, I 2 = 37%). 3,[13][14][15][16]…”

Circulação Extracorpórea

“…Plenty of other knowledge came along with this new technology relating to the physiology of circulation, the body's reactions to surgical aggressions and the domain knowledge in relation to the internal environment, in which all our cells are immersed and where metabolism is developed with the production of energy that makes us live [16][17][18][19][20][21][22][23][24][25][26][27]. These studies resulted in the understanding of homeostasis, a complex system of self-regulation responsible to maintain the multiple vital parameters within normal levels, during production of the energy previously cited.…”