Blog
About

1
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found

      Intensive Care Unit Management of the Critically Ill Patient with Fluid Overload after Open Heart Surgery

      Read this article at

      ScienceOpenPublisherPubMed
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Fluid overload is common before, during and after cardiac surgery. The fluid associated with cardiopulmonary bypass (CPB) and cardioplegia is a particularly important source of such fluid overload. In addition, renal dysfunction, which is common in these patients, participates in the pathogenesis of a positive sodium and water balance. Such fluid overload is physiologically undesirable and participates in the pathogenesis of several clinically important complications. Fluid overload can be partly prevented with the use of diuretics. However, in many patients, diuretics do not achieve sufficient sodium and water diuresis. In these patients, the application of hemofiltration (HF) during CPB and also immediately after CPB is an effective and safe approach to the maintenance of fluid homeostasis. If acute renal failure occurs, early intervention with HF may even improve survival.

          Related collections

          Most cited references 4

          • Record: found
          • Abstract: found
          • Article: not found

          Early and intensive continuous hemofiltration for severe renal failure after cardiac surgery.

          The aim of this study was to test whether early and intensive use of continuous venovenous hemofiltration (CVVH) achieved a better than predicted outcome in patients with severe acute renal failure undergoing cardiac operations, and whether a simple and yet accurate model could be developed to predict their outcome before starting CVVH. Medical record analysis with collection of demographic, clinical, and outcome information was used. Sixty-five consecutive patients were treated with early and intensive CVVH (mean operation to CVVH time, 2.38 days; pump-controlled ultrafiltration rate, 2 L/h) after coronary artery bypass grafting (56.9%), single valve procedure (16.9%), or combined operations (26.2%). In 32.3% of patients, intraaortic balloon counterpulsation was required and 20% of patients were emergencies. Sustained hypotension despite inotropic and vasopressor support occurred in 40% of patients and prolonged mechanical ventilation in 58.5%. Using an outcome prediction score specific for acute renal failure, the predicted risk of death was 66%. Actual mortality was 40% (p = 0.003). Using multivariate logistic regression analysis and neural network analysis, patient outcome could be predicted with good levels of accuracy (receiver operating characteristic 0.89 and 0.9, respectively). Early and aggressive CVVH is associated with better than predicted survival in severe acute renal failure after cardiac operations. Using readily available clinical data, the outcome of such patients can be predicted before the implementation of CVVH.
            Bookmark
            • Record: found
            • Abstract: not found
            • Article: not found

            High-volume hemofiltration improves hemodynamics of endotoxin-induced shock in the pig

              Bookmark
              • Record: found
              • Abstract: not found
              • Article: not found

              Endothelial Cell Injury in Cardiovascular Surgery: The Systemic Inflammatory Response11Recent discoveries in the field of vascular biology have led to an expanded understanding of the pathogenesis of many of the immediate and long-term complications of patients undergoing cardiovascular operations and interventional cardiologic procedures. In particular, the vascular endothelium has emerged as the central focus of many of the biologic events that affect the preoperative, operative, and postoperative course of nearly all heart surgery patients. A recurring theme in the study of endothelial cell biology is the crucial role that endothelial cell injury plays in the difficulties that our patients encounter. The deleterious effects of endothelial cell injury are most evident in the acute syndromes of vasospasm, coagulopathy, ischemia/reperfusion injury, and the systemic inflammatory response to cardiopulmonary bypass. In addition, chronic endothelial cell injury contributes to the development of anastomotic narrowing and the progression of atherosclerosis, both of which limit the long-term success of coronary artery bypass grafting. Because of the increasingly recognized role of the endothelium in cardiovascular function there is a tremendous amount of basic science information detailing the response of the endothelium to injury. This is the fifth in a series of seven reviews intended as an introduction to the major topics of endothelial cell biology that are of importance to the practicing cardiothoracic surgeon. In particular, the authors have focused on the role that the endothelium has on the development of vasomotor dysfunction, bleeding and thrombosis, neutrophil-endothelial cell interaction, and obstructive arteriopathy. The aim of these reviews is to provide a concise reference point for cardiothoracic surgeons as they evaluate the ever-accumulating research findings and new therapies that stem from the study of the endothelium in response to the insults encountered in cardiothoracic surgery.Edward D. Verrier, MD

                Bookmark

                Author and article information

                Journal
                CRD
                Cardiology
                10.1159/issn.0008-6312
                Cardiology
                S. Karger AG
                978-3-8055-7380-1
                978-3-318-00820-3
                0008-6312
                1421-9751
                2001
                2001
                18 January 2002
                : 96
                : 3-4
                : 169-176
                Affiliations
                Departments of aIntensive Care and bCardiothoracic Surgery, Austin and Repatriation Medical Centre, Heidelberg, Vic., Australia; cDivisione di Nefrologia, Ospedale San Bortolo, Vicenza, Italia
                Article
                47400 Cardiology 2001;96:169–176
                10.1159/000047400
                11805383
                © 2002 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 3, Tables: 1, References: 37, Pages: 8
                Categories
                Paper

                Comments

                Comment on this article