Effects of Dexamethasone on Intravascular and Extravascular Fluid Balance in Patients Undergoing Coronary Bypass Surgery with Cardiopulmonary Bypass

Abstract

Extravascular fluid but not extravascular lung water is increased in patients after surgery with cardiopulmonary bypass. Pretreatment of adult patients with 1 mg/kg-1 dexamethasone before coronary bypass grafting decreases extravascular fluid gain and seems to improve postoperative cardiovascular performance. This effect is not caused by a better intravascular volume status.

Perfil clínico da resposta inflamatória sistêmica após cirurgia cardíaca pediátrica com circulação extracorpórea

“…The inflammatory process after CPB has its final lesion characterized by an increase of diffuse capillary permeability with significant liquid extravasation towards the interstitial tissue [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] . This finding could be partially explained by the presence of what is currently called endothelial dysfunction.…”

“…In this context, there is a stimulation of leukocytes, monocytes, macrophages, basophils, endothelial cells, myocytes and hepatocytes. There is an increase in the circulation of complement fractions (mainly C3a, C4a and C5a) 5,6 , citokynes (mainly tumor necrosis factoralpha, class 1, 6, 8 and 10 interleukins) [7][8][9] , histamine 10 and adhesion molecules 11. The inflammatory cascade is then amplified and may be associated with clinical manifestations by fever occurrences 12,13 , myocardial dysfunction (due to mechanical, ischemic and immunological injury) 14,15 and/or vasoplegy 16,17 , with occurrence of hypotension; signs of low cardiac output with hyperperfusion and tissular hypoxia; acute renal insufficiency 18,19 ; acute pulmonary lesion 20 , acute respiratory distress syndrome 21 ; blood dyscrasia 22 , neurological symptoms 23,24 and liquid retention with weight gain down to endothelial lesion 25 . When present, these manifestations may prolong the period of stay in ICU and in general hospital due to aggregated morbidity.…”

Pulmonary function and inflammatory markers in patients undergoing coronary revascularisation with or without cardiopulmonary bypass

“…EVLWI was found to be slightly increased after cardiac surgery with CPB, being higher in nonpulsatile than in pulsatile CPB [16], when a crystalloid prime was used vs a colloid prime [29] and when the colloid osmotic pressure during CPB is maintained at normal levels [17]. It is lower when steroids are given [18], indicating the sensitivity of this parameter. Some previous studies have failed to show any beneficial effect on pulmonary gas exchange of off-pump techniques [4][5][6][7][8].…”

“…different studies and ⁄ or institutions is extremely difficult because the magnitude of the inflammatory response is largely affected by the CPB management. Indeed, biocompatible materials, filters, pulsatility of flow, prime, cardiotomy suction and use of anti-inflammatory medications are all factors that affect the severity of the inflammatory response or its consequences [16][17][18][19]. In our institution, we routinely use biocompatible materials, filters, pulsatile flow and restrict cardiotomy suction.…”

Use of Hypertonic Sodium Chloride Solution at Surgery under Extracorporeal Circulation

“…Повыше ние капиллярной проницаемости при проведении ИК являет ся одной из основных причин нарушения баланса жидкости при кардиохирургических вмешательствах [1]. Объем интер стициальной жидкости в течение операции на сердце в услови ях ИК увеличивается с одновременным уменьшением объема циркулирующей крови (ОЦК) [2,3], что способствует разви тию осложнений в послеоперационном периоде [4]. Несмотря на наличие в арсенале анестезиологов широкого спектра крис таллоидных и коллоидных препаратов, вопрос выбора опти мального раствора для проведения инфузионной терапии в кардиохирургии остается все еще открытым.…”