Sage Journals: Discover world-class research

Abstract

Aims

To evaluate the roles of intraoperative changes in plasma osmolarity and pump time as predictor factors on postoperative hemodynamic instability and mid-term clinical outcomes, in adults undergoing cardiovascular surgeries with cardiopulmonary bypass.

Methods

This observational study included 172 adults undergoing cardiovascular surgery with cardiopulmonary bypass. Intraoperative changes in calculated plasma osmolarity were calculated from biochemical analyses of venous blood samples. Outcomes included the requirement for vasoactive drugs 24 hours postoperatively and mortality at 2 years. Multivariate logistic regression models adjusted for EuroSCORE II were used to analyze the data.

Results

Both changes in calculated plasma osmolarity (OR = 1.78; 95% CI 1.18–2.27; p = .0074) and pump time (OR = 1.18; 95% CI 1.05–1.35; p = .0090) were independently associated with higher odds of requiring vasoactive drugs 24 hours postoperatively. At 2 years, changes in calculated plasma osmolarity (OR = 1.99, 95% CI 1.15–3.42; p = .0114) were associated with the combined outcome of death, hospitalization, and/or repeat cardiovascular surgery, independently of pump time (OR = 1.01; 95% CI 0.98–1.03; p = .2340), but not to mortality alone.

Conclusions

Changes in plasma osmolarity and pump time during cardiopulmonary bypass were associated with postoperative hemodynamic instability. Additionally, changes in plasma osmolarity were associated with adverse outcomes at 2 years.

Keywords

plasma osmolarity pump time cardiopulmonary bypass extracorporeal circulation pump cardiovascular surgery

Get full access to this article

View all access options for this article.

References

Ltaief

Ben-Hamouda

Rancati

, et al. Vasoplegic syndrome after cardiopulmonary bypass in cardiovascular surgery: pathophysiology and management in critical care. J Clin Med 2022; 11(21): 6407.

Giacinto

Satriano

Nenna

, et al. Inflammatory response and endothelial dysfunction following cardiopulmonary bypass: pathophysiology and pharmacological targets. Recent Pat Inflamm Allergy Drug Discov 2019; 13(2): 158–173.

Ljunggren

Sköld

Dardashti

, et al. The use of mannitol in cardiopulmonary bypass prime solution: prospective randomized double-blind clinical trial. Acta Anaesthesiol Scand 2019; 63(10): 1298–1305.

Lomivorotov

Fominskiy

Efremov

, et al. Hypertonic solution decreases extravascular lung water in cardiac patients undergoing cardiopulmonary bypass surgery. J Cardiothorac Vasc Anesth 2013; 27(2): 273–282.

Oztekin

Gökdoğan

Oztekin

, et al. Effects of propofol and midazolam on lipids, glucose, and plasma osmolality during and in the early postoperative period following coronary artery bypass graft surgery: a randomized trial. Yakugaku Zasshi 2007; 127(1): 173–182.

Read

Manners

. Osmolal excretion after open heart surgery. Anaesthesia 1983; 38(11): 1053–1061.

Ghadimi

Gutsche

Ramakrishna

, et al. Sodium bicarbonate use and the risk of hypernatremia in thoracic aortic surgical patients with metabolic acidosis following deep hypothermic circulatory arrest. Ann Card Anaesth 2016; 19(3): 454–462.

Maddali

Waje

Arora

, et al. Effect of low-dose dexamethasone on extravascular lung water in patients following on-pump elective primary coronary artery bypass graft surgery. Ann Card Anaesth 2019; 22(4): 372–378.

Honkonen

Järvelä

Huhtala

, et al. Hyperosmolality does not modulate natriuretic peptide concentration in patients after coronary artery surgery. Acta Anaesthesiol Scand 2009; 53(5): 565–572.

10.

Lindner

Zapletal

Schwarz

, et al. Acute hyponatremia after cardioplegia by histidine-tryptophane-ketoglutarate: a retrospective study. J Cardiothorac Surg 2012; 7: 52.

11.

Molter

Silomon

Bauer

, et al. Effects of hyperoncotic or hypertonic-hyperoncotic solutions on polymorphonuclear neutrophil count, elastase- and superoxide-anion production: a randomized controlled clinical trial in patients undergoing elective coronary artery bypass grafting. Acta Anaesthesiol Scand 2007; 51(7): 914–921.

12.

Järvelä

Kaukinen

. Hypertonic saline (7.5%) after coronary artery bypass grafting. Eur J Anaesthesiol 2001; 18(2): 100–107.

13.

Bauer

Kortgen

Hartog

, et al. Isotonic and hypertonic crystalloid solutions in the critically ill. Best Pract Res Clin Anaesthesiol 2009; 23(2): 173–181.

14.

Jucá

Freitas

Goncharov

, et al. Difference between cardiopulmonary bypass time and aortic cross-clamping time as a predictor of complications after coronary artery bypass grafting. Braz J Cardiovasc Surg 2024; 39(2): e20230104.

15.

Liu

, et al. Cardiopulmonary bypass time is an independent risk factor for acute kidney injury in emergent thoracic aortic surgery: a retrospective cohort study. J Cardiothorac Surg 2019; 14(1): 90.

16.

Salsano

Giacobbe

Sportelli

, et al. Aortic cross-clamp time and cardiopulmonary bypass time: prognostic implications in patients operated on for infective endocarditis. Interact Cardiovasc Thorac Surg 2018; 27(3): 328–335.

17.

Madhavan

Chan

Tan

, et al. Cardiopulmonary bypass time: every minute counts. J Cardiovasc Surg 2018; 59(2): 274–281.

18.

Chalmers

Pullan

Mediratta

, et al. A need for speed? Bypass time and outcomes after isolated aortic valve replacement surgery. Interact Cardiovasc Thorac Surg 2014; 19(1): 21–26.

19.

Likosky

Goldberg

DiScipio

, et al. Variability in surgeons' perioperative practices may influence the incidence of low-output failure after coronary artery bypass grafting surgery. Circ Cardiovasc Qual Outcomes 2012; 5(5): 638–644.

20.

Nissinen

Biancari

Wistbacka

, et al. Safe time limits of aortic cross-clamping and cardiopulmonary bypass in adult cardiac surgery. Perfusion 2009; 24(5): 297–305.

21.

Salis

Mazzanti

Merli

, et al. Cardiopulmonary bypass duration is an independent predictor of morbidity and mortality after cardiac surgery. J Cardiothorac Vasc Anesth 2008; 22(6): 814–822.

22.

Tkebuchava

Tasar

Lehmann

, et al. Predictors of outcome for aortic valve reimplantation including the surgeon: a single-center experience. Thorac Cardiovasc Surg 2020; 68(7): 567–574.

23.

Algarni

Maganti

Yau

. Predictors of low cardiac output syndrome after isolated coronary artery bypass surgery: trends over 20 years. Ann Thorac Surg 2011; 92(5): 1678–1684.

24.

Nashef

Roques

Sharples

, et al. EuroSCORE II. Eur J Cardio Thorac Surg 2012; 41(4): 734–744.

25.

Society of Thoracic Surgeons Blood Conservation Guideline Task Force Ferraris

Brown

, et al. 2011 update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists blood conservation clinical practice guidelines. Ann Thorac Surg 2011; 91(3): 944–982.

26.

Lazar

McDonnell

Chipkin

, et al. The Society of Thoracic Surgeons practice guideline series: blood glucose management during adult cardiac surgery. Ann Thorac Surg 2009; 87(2): 663–669.

27.

Chen

Hao

, et al. Agreement of measured and calculated serum osmolality during the infusion of mannitol or hypertonic saline in patients after craniotomy: a prospective, double-blinded, randomised controlled trial. BMC Anesthesiol 2015; 15: 138.

28.

García-Morales

Cariappa

Parvin

, et al. Osmole gap in neurologic-neurosurgical intensive care unit: its normal value, calculation, and relationship with mannitol serum concentrations. Crit Care Med 2004; 32(4): 986–991.

29.

Vánky

Håkanson

Svedjeholm

. Long-term consequences of postoperative heart failure after surgery for aortic stenosis compared with coronary surgery. Ann Thorac Surg 2007; 83(6): 2036–2043.

30.

Jiang

Holm

Friberg

, et al. Utility of NT-proBNP as an objective marker of postoperative heart failure after coronary artery bypass surgery: a prospective observational study. Perioper Med 2021; 10(1): 21.

31.

Politi

Di Benedetto

Ferreyra

, et al. Caracterización y predicción del riesgo de cirugías cardiovasculares con uso de bomba de circulación extracorpórea [Characterization and risk prediction of cardiovascular surgeries with cardiopulmonary bypass: a cross-sectional study]. Rev Fac Cien Med Univ Nac Cordoba 2024; 81(2): 233–253.

32.

Borracci

Rubio

Baldi

Jr , et al. Mortality in low- and very low-risk patients undergoing cardiac surgery: evaluation according to the EuroSCORE II as a new standard. Cardiol J 2015; 22(5): 495–500.

33.

Arangalage

Cimadevilla

Alkhoder

, et al. Agreement between the new EuroSCORE II, the Logistic EuroSCORE and the Society of Thoracic Surgeons score: implications for transcatheter aortic valve implantation. Arch Cardiovasc Dis 2014; 107(6–7): 353–360.

34.

Robertson

Aycinena

Zerbe

. Neurogenic disorders of osmoregulation. Am J Med 1982; 72(2): 339–353.

35.

Poullis

Warwick

Sastry

, et al. Hypertonic cardiopulmonary bypass primes and endothelial damage. J Extra Corpor Technol 2008; 40(4): 236–240.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

1.19 MB

Clinical impact of changes in plasma osmolarity and pump time during cardiopulmonary bypass use