Fluid Overload after Coronary Artery Bypass Grafting Surgery Increases the Incidence of Post-Operative Complications

Abstract

This study is a prospective trial comparing the incidence of post-operative complications to fluid status in patients undergoing coronary artery bypass grafting (CABG) surgery. One hundred and nine subjects undergoing CABG surgery at the Jewish general hospital were recruited over a 5 months period in the year 2006. All of the patients underwent CABG surgery "on pump". Post operative fluid overload was measured by weight gain. Using logistic regression with complications (major vs. minor only/none) as an outcome and fluid overload as a covariate, the risk of major complications significantly increases for fluid overload ≥5 kg compared to 1-5 kg (p < 0.001), while the risk for ≤1 kg is not significantly different from 1-5 kg. Also, the risk of major complications significantly (p = 0.012) increases for days with fluid overload ≥5 days in comparison to ≤1 day.

Bedside Ultrasonographic Measurement of the Inferior Vena Cava Fails to Predict Fluid Responsiveness in the First 6 Hours After Cardiac Surgery: A Prospective Case Series Observational Study

“…[20][21][22] Moreover, it has been documented that during cardiopulmonary bypass (CPB), patients are exposed to significant fluid overload. 2,3 In the present study, 84% of patients had positive fluid balance immediately after CPB. Total fluid balance was 759.6 Ϯ 935.6 mL at baseline (immediately after the cardiac procedure when the patient was transferred to the …”

“…Accumulating data suggest that underperfusion leads to inadequate organ perfusion, whereas overzealous perfusion is related to postoperative complications, increased hospital stay, and mortality. [1][2][3][4][5][6] Hence, the goal of the volume therapy is to supplement cardiac filling volume only as long as it improves stroke volume. The term "fluid responsiveness" describes this relation and justifies fluid challenge if it stays on the volume-dependent steep portion of the Frank-Starling curve.…”

Microvascular fluid exchange during pulsatile cardiopulmonary bypass perfusion with the combined use of a nonpulsatile pump and intra-aortic balloon pump

“…Restrictive perioperative fluid therapy has been associated with improved postoperative organ function, a lower incidence of postoperative complications, and, probably, shorter hospital stays 21 in contrast to a highly positive intraoperative fluid balance (>5 L), which has been associated with adverse outcomes. 22 The perfusion mode and flow pattern are among a number of factors that can affect fluid accumulation during CPB. 9,23 Considerable evidence in favor of pulsatile CPB flow has accumulated from studies of neonates, infants, small children, and animals, 23 in which the damaging effects on erythrocytes and thrombocytes were similar with pulsatile and nonpulsatile perfusion.…”

Does insulin impact cold-induced fluid- and protein-extravasation?

“…Hypothermia is associated with fluid accumulation contributing to increased morbidity and mortality [20,24]. Studies aimed to prevent fluid overloading could thereby potentially represent an improvement in patient handling and treatment.…”