Effect of different priming fluids on extravascular lung water, cell integrity and oxidative stress in cardiopulmonary bypass surgery

BACKGROUND

Discussions continue on the ideal priming fluid in adult cardiac surgery. The purpose of this prospective study was to evaluate the effects of different types of priming fluids on extravascular lung water, cell integrity and oxidative stress status.

METHODS

Thirty elective coronary artery bypass surgery patients were randomised prospectively into two groups. The first group received colloid priming fluid, while the second group received crystalloid priming fluid. Extravascular lung water index, advanced oxidative protein products, total thiol, free haemoglobin, ischaemic modified albumin and sialic acid levels were measured. Moreover, intra-operative and postoperative outcomes were reviewed.

RESULTS

There were no significant differences between the groups with regard to extravascular lung water index, oxidative stress parameters or cell integrity (p > 0.05). Similarly, no significant differences were observed between the patients with regard to intra-operative and postoperative outcomes (p > 0.05).

CONCLUSIONS

The presumed superiority of colloidal priming for cardiopulmonary bypass could not be confirmed in our study.

Assessment of lung edema during ex-vivo lung perfusion by single transpulmonary thermodilution: A preliminary study in humans

BACKGROUND

Single transpulmonary thermodilution (SD) with extravascular lung water index (EVLWI) could become a new tool to better assess lung graft edema during ex-vivo lung perfusion (EVLP). In this study we compare EVLWI with conventional methods to better select lungs during EVLP and to predict post-transplant primary graft dysfunction (PGD).

METHODS

We measured EVLWI, arterial oxygen/fraction of inspired oxygen (P/F) ratio, and static lung compliance (SLC) during EVLP in an observational study. At the end of EVLP, grafts were accepted or rejected according to a standardized protocol blinded to EVLWI results. We compared the respective ability of EVLWI, P/F, and SLC to predict PGD. Mann-Whitney U-test, Fisher's exact test, and receiver-operating characteristic (ROC) curve data were used for analysis. p < 0.05 was considered statistically significant.

RESULTS

Thirty-five lungs were evaluated by SD during EVLP. Three lungs were rejected for pulmonary edema. Thirty-two patients were transplanted, 8 patients developed Grade 2 or 3 PGD, and 24 patients developed Grade 0 or 1 PGD. In contrast to P/F ratio, SLC, and pulmonary artery pressure, EVLWI differed between these 2 populations (p < 0.001). The area under the ROC for EVLWI assessing Grade 2 or 3 PGD at the end of EVLP was 0.93. Donor lungs with EVLWI >7.5 ml/kg were more likely associated with a higher incidence of Grade 2 or 3 PGD at Day 3.

CONCLUSIONS

Increased EVLWI during EVLP was associated with PGD in recipients.

Evaluation of Cardiac Index and Extravascular Lung Water After Single-Lung Transplantation Using the Transpulmonary Thermodilution Technique by the PiCCO2 Device

OBJECTIVES

First evaluation of the transpulmonary thermodilution technique by the PiCCO2 device to assess cardiac index and pulmonary edema during the postoperative course after single-lung transplantation.

DESIGN

Prospective observational study.

SETTINGS

Intensive care unit, university hospital (single center).

PARTICIPANTS

Single-lung transplant patients.

INTERVENTIONS

The authors compared cardiac index measured by PiCCO2 and pulmonary artery catheter and assessed pulmonary edema using extravascular lung water index and pulmonary vascular permeability index measured by PiCCO2.

MEASUREMENTS AND MAIN RESULTS

A Bland-Altman method was used to compare cardiac index measured by PiCCO2 and pulmonary artery catheter. Extravascular lung water index and pulmonary vascular permeability index were compared according to the PaO₂/FiO₂ ratio with a threshold value of 150 mmHg. Ten single-lung transplant patients were included. Cardiac index measured by PiCCO2 and pulmonary artery catheter were 3.3 L/min/m² (2.9-3.6) and 2.5 L/min/m² (2.2-3.0). Bias for cardiac index was 0.71 L/min/m² (-0.03; 1.44) and limit of agreements were -0.03 and 1.44 L/min/m². Extravascular lung water index was 12 mL/kg (11-16) and pulmonary vascular permeability index was 2.3 (2.0-3.1), consistent with pulmonary edema. Extravascular lung water index was higher in the group of PaO₂/FiO₂ ratio ≤150 mmHg compared with the group of PaO₂/FiO₂ ratio >150 mmHg (17 v 12 mL/kg, p = 0.04), whereas pulmonary vascular permeability index only tended to be higher (3.1 v 2.1, p = 0.06).

CONCLUSION

PiCCO2 device systematically overestimated cardiac index compared with pulmonary artery catheter. However, it might be useful to assess pulmonary edema in acute respiratory failure after single-lung transplantation.

Extravascular lung water monitoring of renal replacement therapy in lung water scavenging for septic acute kidney injury

This study aims to investigate the extravascular lung water index (EVLWI) in lung water scavenging of sepsis patients with acute kidney injury (AKI) by renal replacement therapy (RRT). 57 septic acute kidney injury patients with EVLWI > 7 ml/kg were selected and randomly divided into two groups: the treatment group with continued RRT for 24 h per day, the control group with RRT for ≤8 h per day. Fluid resuscitation and RRT were performed simultaneously. After fluid resuscitation, EVLWI, hemodynamics, oxygenation index, blood lactate, and intensive care unit (ICU) stay were determined. The values of EVLWI, pulmonary vascular permeability index (PVPI), and blood lactate decreased and the intrathoracic blood volume index (ITBVI) increased significantly at 24 h, 48 h and 72 h, after RRT, compared with those before RRT in the two groups (P < 0.05). The values of EVLWI at 48 h and 72 h after RRT in the treatment group were significantly lower than that in the control group (P < 0.05). The cardiac index (CI) at 48 h and 72 h after RRT in the treatment group was significantly higher than that before RRT (P < 0.05). The values of PVPI, ITBVI, CI, blood lactate, transcutaneous oxygen saturation pulse (SPO2), oxygenation index (PO2/FiO2) and arterial oxygen (PO2) before and 24 h, 48 h, and 72 h after RRT. The 28d mortality had no significant difference in the two groups (P > 0.05). The average ICU stay for the treatment group was significantly shorter than that of the control group (P < 0.05). EVLWI monitoring of septic patients with AKI in RRT time had clinical reference value.

The effects of differential injection sites of cold saline on transpulmonary thermodilution parameter values

AIM

To investigate the effects of differential sites for cold saline injection on transpulmonary thermodilution parameter values.

METHODS

This was a prospective study. Twelve patients were recruited for the following examinations: control condition (injection site at proximal injection end of the Swan-Ganz catheter), proximal end condition (injection site at sheath of the Swan-Ganz catheter), and distal end condition (injection site at PA end of the Swan-Ganz catheter). Sixty measurements were performed for each condition. The cardiac index, global end diastolic volume index (GEDI), and extravascular lung water index for the three different injection sites were recorded from each patient. In addition, the mean transmission time (MTt), downslope time, and area under the curve obtained from PiCCO-VoLEF-Win software were compared among different groups.

RESULTS

There were no differences in cardiac index and extravascular lung water index values among the three conditions (P>0.05). There were no differences in GEDI between the proximal end condition and control condition (P>0.05), while the GEDI was significantly lower for the distal end condition (493.33±254.65 mL/m(2)) than for the control condition (645.53±234.46 mL/m(2)) (P<0.05) and proximal end condition (717.96±321.63 mL/m(2)) (P<0.01). There were no differences in downslope time and area under the curve among the three conditions (P>0.05). There were no differences in MTt between the proximal end condition and control condition (P>0.05), while the MTt was significantly lower for distal end condition (40.22±16.37 seconds) than for the control condition (42.91±17.93 seconds) (P<0.05) and proximal end condition (47.16±16.64 seconds) (P<0.01).

CONCLUSION

The differential sites for cold saline injection impacted transpulmonary thermodilution parameter values.