Effect of ultrafiltration on extravascular lung water assessed by lung ultrasound in children undergoing cardiac surgery: a randomized prospective study

Elayashy, Mohamed; Madkour, Mai A.; Mahmoud, Ahmed Abdelaal Ahmed; Hosny, Hisham; Hussein, A.; Nabih, Ahmed; Lofty, Ahmed; Hamza, Hamza Mohamed; Hassan, Passaint; Wagih, Mohamed; Mohamed, Ahmed K.

doi:10.1186/s12871-019-0771-1

Cited by 13 publications

(5 citation statements)

References 28 publications

(27 reference statements)

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“…An increase in B-lines caused worsening oxygenation as measured by PaO 2 /FiO 2 and was associated with longer periods of ventilation. This finding is in agreement with a randomized control trial where LUS was used in congenital heart surgery in which two groups were compared: one with conventional ultrafiltration and the control which did not receive ultrafiltration [ 9 ]. At the end of the surgery, there was a negative correlation with PaO 2 /FiO 2 and LUS score.…”

Section: Discussionsupporting

confidence: 88%

Extravascular Lung Water and Effect on Oxygenation Assessed by Lung Ultrasound in Adult Cardiac Surgery

Emperador¹,

Bennett²,

Gonzalez³

et al. 2020

Cureus

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Introduction The extravascular lung water content is determined by the use of lung ultrasound (LUS) which is represented as B-lines. The aim of this study was to investigate whether the LUS measurement of extravascular lung water was correlated to changes in oxygenation. Methods This prospective cohort study was comprised of 73 patients with an average age of 56 (range: 18 to 87 years) who underwent elective cardiac surgery using cardiopulmonary bypass. The LUS score was performed preoperatively, time zero (T0), at one hour (T1), and at 24 hours (T2) post-surgery. Additionally, arterial oxygen partial pressure and fraction of inspired oxygen (PaO 2 /FiO 2 ) ratio were measured at each time and the time-to-extubation. Results A negative correlation was found between the LUS score and PaO 2 /FiO 2 at T1 (p < 0.004). Extubation time and changes in the lung ultrasound score at T0 - T2 were positively correlated (p < 0.03). Plus, there was a positive correlation between fluid balance and lung ultrasound score at T2 (p < 0.03). Conclusion We found three significant correlations that support the use of LUS in cardiac surgery: 1) the more B-lines, the lower the oxygenation; 2) the more B-lines, the longer the period of ventilation; 3) the more B-lines, the more positive the fluid balance. LUS is a non-invasive bedside investigation that can be used to judge extravascular lung water, providing useful information in the management of patient oxygenation, fluid balance, and extubation.

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Section: Discussionsupporting

confidence: 88%

Extravascular Lung Water and Effect on Oxygenation Assessed by Lung Ultrasound in Adult Cardiac Surgery

Emperador¹,

Bennett²,

Gonzalez³

et al. 2020

Cureus

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“…The lung ischemia-reperfusion injury also contributes to lung inflammation [16]. The lung inflammation leads to an increase in pulmonary microvascular permeability and deteriorates lung compliance, increases airway resistance and then aggravates alveolar gas exchange [15,17]. Our study results suggested that prophylactic EPO improved lung compliance, increased gas exchange function, and reduced lung airway pressure.…”

Section: Discussionmentioning

confidence: 57%

“…In this study, we found that EPO improved the respiratory mechanics after CPB. During CPB, contact of blood with the CPB circulation tube activates the inflammatory cell releasing lots of inflammatory factors [15]. These inflammatory factors can directly damage endothelial cells.…”

Section: Discussionmentioning

confidence: 99%

Effects of Erythropoietin on Lung Injury Induced by Cardiopulmonary Bypass After Cardiac Surgery

Lin

Cui

et al. 2020

Med Sci Monit

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Background:Lung injury after cardiopulmonary bypass (CPB) is a serious postoperative complication and can affect the postoperative recovery. The purpose of this study was to explore whether erythropoietin (EPO) has an effect on lung injury caused by CPB. Material/Methods:Sixty patients who received the CPB were randomly divided into a saline group and the EPO group. All the patients received saline or EPO preoperatively, respectively. The ventilation function, including dynamic compliance, peak airway pressure, and plateau pressure, were recorded. The level of tumor necrosis factor (TNF)-a, interleukin (IL)-1b, and IL-10 in serum and arterial blood gas were analyzed. The mechanical ventilation time in the intensive care unit (ICU), the length of time spent in the ICU, the time from operation to discharge, and the total time of hospitalization were recorded. Adverse events in the ICU were monitored and recorded. Results:EPO significantly decreased the level of TNF-a and IL-1b, but increased the level of IL-10 after CPB. EPO significantly improved pulmonary ventilated function and gas exchange function after CPB. EPO significantly shortened the mechanical ventilation time and stay in the ICU. Conclusions:Preoperative EPO injection reduced lung injury and promoted lung function in patients who underwent CPB.The protection effect of EPO may be associated with inhibition of inflammatory response.

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“…This is, however, is at times not cost-effective for some patients and controversial results in some. 10 Diuretic therapy is a routine part of management of patients with congestive cardiac failure. This is cheap and easily available.…”

Section: Discussionmentioning

confidence: 99%

Does Intraoperative Diuretic Therapy Affect the Thoracic Fluid Content and Clinical Outcome in Patients Undergoing Mitral Valve Surgery?

Choudhury

Narula

Saini

et al. 2020

Journal of Cardiac Critical Care TSS

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Pulmonary congestion is inevitable in valvular heart disease. The condition worsens when a patient undergoes cardiopulmonary bypass (CPB). Thoracic fluid content (TFC) is an indicator of total volume status of lung in health and disease. We hypothesize that intraoperative diuretic therapy can improve the hemodynamic and clinical outcome in patients undergoing mitral valve surgery by decreasing TFC as measured by impedance cardiography (ICG).Sixty adult patients with critical mitral stenosis scheduled for mitral valve surgery divided into diuretic (Gr D, n = 30) and control (Gr C, n = 30) group. One mg/kg of furosemide was administered before CPB to Gr D and similar volume of normal saline to Gr C. Hemodynamic and TFC measurements were done by index of contractility (ICON), NICOM monitor at baseline, before anesthesia induction (T1), post skin closure (T2), postoperatively at 6th hour (T3), 24th hour (T4), and 48th hour (T5). The duration of mechanical ventilation (hour), intensive care unit stay (day) and inotropic score was significantly higher in Gr C (5.29 ± 1.4 vs. 2.15 ± 1.1; p = 0.001; 2.11 ± 0.64 vs. 1.67 ± 0.57, p = 0.002; 9 ± 5.4 vs. 5.8 ± 3.2, p = 0.05), respectively. Three patients in Gr C developed respiratory complication during their course of hospital stay. The baseline TFC value was comparable (p = 0.08). In Gr C. it gradually increased over time and never reached the baseline value, whereas in Gr D, there was slight increase in TFC till 6th postoperative hour and it came below the baseline value at 48th hour. A significantly higher TFC value in Gr C in comparison with Gr D from 6th to 48th postoperative hour (p = 0.005, 0.000, and 0.005, respectively) was observed.The ICON had a gradual improvement from 12th over 48th postoperative hour in Gr D in comparison to Gr C. The systemic vascular resistance index was decreased over time in Gr C, whereas in Gr D there was a mild fall at the end of surgery and it came back to near the baseline value at 48th postoperative hour. A continuous decrease in DO2 I except at 6th postoperative hour was seen in Gr C, whereas it remained near the baseline value in Gr D.Linear regression analysis showed significant direct correlation of TFC with intraoperative fluid balance (r = 0.524, p = 0.001), cumulative fluid balance (r = 0.680, p = 0.000) and both peak and mean airway pressure (r = 0.436, p = 0.001 and r = 0.548, p = 0.001, respectively).We concluded that TFC is clearly influenced by intraoperative diuretic therapy. A decrease in TFC has an association with better hemodynamic parameters that could find interesting clinical applications in the decision, whether or not to include a diuretic as a routine therapy during intraoperative management in valve surgery patients.

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Effect of ultrafiltration on extravascular lung water assessed by lung ultrasound in children undergoing cardiac surgery: a randomized prospective study

Cited by 13 publications

References 28 publications

Extravascular Lung Water and Effect on Oxygenation Assessed by Lung Ultrasound in Adult Cardiac Surgery

Extravascular Lung Water and Effect on Oxygenation Assessed by Lung Ultrasound in Adult Cardiac Surgery

Effects of Erythropoietin on Lung Injury Induced by Cardiopulmonary Bypass After Cardiac Surgery

Does Intraoperative Diuretic Therapy Affect the Thoracic Fluid Content and Clinical Outcome in Patients Undergoing Mitral Valve Surgery?

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