Cardiopulmonary Bypass Management Using High-volume Continuous Hemofiltration in Patients with Comorbidities

Özet

Objectives: To evaluate the effectiveness of hemofiltration during longstanding cardiopulmonary bypass (CPB) in patients with comorbidities. Materials and Methods: Prospective randomized clinical trial included 38 male patients with ex-pecting duration of CPB >120 minutes due to comorbid pathology. Standard anesthesia protocol was carried out. Study includes two groups: first group (controlled, n=20) included standard CPB, 2nd group (analyzed, n=18) included perfusion with high-volume hemofiltration using polyionic buffered solution 80 mL/min during all CPB time. Hemofiltration has been also supported by ultra-filtration for hydro-balance maintenance at the level of 8-10 mL/kg. Laboratory tests, respiratory and renal complications, drainage blood loss, hemostasis disorders, requiring hemostatics and blood transfusion, intensive care unit (ICU) and in-hospital were evaluated. Nonparametric methods-Mann-Whitney U test for independent samples and Wilcoxon signed-rank test for dependent samples were used. Results: IL-6 level in 2nd group was significantly lower (p=0.0017) and did not exceed 7.4 pg/mL. C-RP, metalloproteinase and procalcitonin levels were lower too, but not statistically significant. Lactate level in analyzed group was in reference range, while in control group after perfusion it in-creased to 8.3±4.2 mmol/L. Renal dysfunction, requiring dialysis, was diagnosed in six (20,7%) patients from controlled group vs two patients (6.1%) from analyzed group. Respiratory insufficiency developed in three patients (10.3%) only in controlled group. In-hospital stay was significantly lower in analyzed group and so was the ICU length. Polyorganic insufficiency syndrome occurred in three patients (10.3%) from the controlled group. Conclusion: High-volume hemofiltration using polyionic buffered solution for longstanding CPB reduces damaging effects of traditional roller pump and reduces risks of organic dysfunction in postoperative period.