4
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Effects of crystalloid and colloid priming strategies for cardiopulmonary bypass on colloid oncotic pressure and haemostasis: a meta-analysis

      review-article

      Read this article at

      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

          OBJECTIVES

          Colloid oncotic pressure (COP) is an important factor in cardiac surgery, owing to its role in haemodilution. The effect of cardiopulmonary bypass prime fluids on the COP is unknown. In this study, the effect of crystalloid and colloid prime fluids, with or without retrograde autologous priming (RAP), on the COP during elective cardiac surgery was evaluated.

          METHODS

          Randomized controlled trials and prospective clinical trials comparing crystalloid and colloid priming fluids or with RAP were selected. The primary outcome was the COP; secondary outcomes were fluid balance, fluid requirements, weight gain, blood loss, platelet count and transfusion requirements.

          RESULTS

          From 1582 records, 29 eligible studies were identified. COPs were comparable between gelofusine and hydroxyethyl starch (HES) during bypass [mean difference (MD): 0.69; 95% confidence interval (CI): −2.05, 3.43; P = 0.621], after bypass (MD: −0.11; 95% CI: −2.54, 2.32; P = 0.930) and postoperative (MD: −0.61; 95% CI: −1.60, 0.38; P = 0.228). Fluid balance was lower with HES than with crystalloids. RAP reduced transfusion requirements compared with crystalloids. Blood loss was comparable between groups.

          CONCLUSIONS

          COPs did not differ between crystalloids and colloids. As a result of increased transcapillary fluid movement, fluid balance was lower with HES than with crystalloids. Haematocrit and transfusion requirements were comparable between groups. However, the latter was lower when RAP was applied to crystalloid priming compared with crystalloids alone. Finally, no differences in blood loss were observed between the groups.

          Abstract

          Colloid oncotic pressure (COP), determined by all plasma proteins in the intra- and extravascular compartments, plays a key role in transcapillary fluid movement.

          Related collections

          Most cited references53

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

          Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

          David Moher and colleagues introduce PRISMA, an update of the QUOROM guidelines for reporting systematic reviews and meta-analyses
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Microvascular fluid exchange and the revised Starling principle.

            Microvascular fluid exchange (flow J(v)) underlies plasma/interstitial fluid (ISF) balance and oedematous swelling. The traditional form of Starling's principle has to be modified in light of insights into the role of ISF pressures and the recognition of the glycocalyx as the semipermeable layer of endothelium. Sum-of-forces evidence and direct observations show that microvascular absorption is transient in most tissues; slight filtration prevails in the steady state, even in venules. This is due in part to the inverse relation between filtration rate and ISF plasma protein concentration; ISF colloid osmotic pressure (COP) rises as J(v) falls. In some specialized regions (e.g. kidney, intestinal mucosa), fluid absorption is sustained by local epithelial secretions, which flush interstitial plasma proteins into the lymphatic system. The low rate of filtration and lymph formation in most tissues can be explained by standing plasma protein gradients within the intercellular cleft of continuous capillaries (glycocalyx model) and around fenestrations. Narrow breaks in the junctional strands of the cleft create high local outward fluid velocities, which cause a disequilibrium between the subglycocalyx space COP and ISF COP. Recent experiments confirm that the effect of ISF COP on J(v) is much less than predicted by the conventional Starling principle, in agreement with modern models. Using a two-pore system model, we also explore how relatively small increases in large pore numbers dramatically increase J(v) during acute inflammation.
              Bookmark
              • Record: found
              • Abstract: not found
              • Article: not found

              On the Absorption of Fluids from the Connective Tissue Spaces.

                Bookmark

                Author and article information

                Journal
                Interact Cardiovasc Thorac Surg
                Interact Cardiovasc Thorac Surg
                icvts
                Interactive Cardiovascular and Thoracic Surgery
                Oxford University Press
                1569-9293
                1569-9285
                September 2022
                05 May 2022
                05 May 2022
                : 35
                : 3
                : ivac127
                Affiliations
                [1 ] Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Anaesthesiology , Amsterdam, Netherlands
                [2 ] Amsterdam UMC Location University of Amsterdam, Department of Cardiothoracic Surgery , Amsterdam, Netherlands
                Author notes
                Corresponding author. Amsterdam UMC Location Vrije Universiteit Amsterdam, Department of Anaesthesiology, Amsterdam, Netherlands. Tel: +31-20-444 4444; e-mail: a.beukers@ 123456amsterdamumc.nl (A. Beukers).
                Author information
                https://orcid.org/0000-0002-9153-7924
                Article
                ivac127
                10.1093/icvts/ivac127
                9419694
                35512381
                287c3bda-5ec0-4c3e-8d0b-18906085e42c
                © The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 31 January 2022
                : 11 April 2022
                : 02 May 2022
                : 12 May 2022
                Page count
                Pages: 4
                Categories
                Extracorporeal Technologies
                Meta-Analysis
                Eacts/102
                Eacts/103
                Eacts/118
                Eacts/105
                AcademicSubjects/MED00920

                colloid oncotic pressure,prime fluid,cardiopulmonary bypass,cardiac surgery

                Comments

                Comment on this article