CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 2, May – August 2024 70 AFRICA Cardiovascular Topics Effect of different priming fluids on extravascular lung water, cell integrity and oxidative stress in cardiopulmonary bypass surgery Halim Ulugöl, Meltem Güner Can, Uğur Aksu, Kubra Vardar, Murat Ökten, Fevzi Toraman Abstract 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. Keywords: priming fluid, extravascular lung water index, oxidative stress, cell integrity Submitted 19/11/22, accepted 8/2/23 Published online 6/3/23 Cardiovasc J Afr 2024; 35: 70–74 www.cvja.co.za DOI: 10.5830/CVJA-2023-006 Coronary artery bypass grafting (CABG) causes an acute inflammatory response, which results in systemic inflammatory response syndrome (SIRS), leading to organ damage.1-3 In cardiopulmonary bypass (CPB) circuits, non-physiological environmental factors such as foreign surfaces, haemodilution, non-pulsatile flow and temperature variations can induce an inflammatory response. Furthermore, the balance between pro- and anti-oxidant mediators is disturbed, resulting in excessive accumulation of reactive oxygen species.4 In turn, this redox imbalance, which is called oxidative stress, triggers the inflammatory response and initiates an oxidative vicious circle.2,5 Inflammatory processes accompanied by oxidative stress can affect the barrier function of the plasma membrane, leading to changes in intra- and extravascular volume status.6 Pulmonary oedema is a complication following CABG. Accumulation of extravascular lung water (EVLW), as a consequence of increased permeability or increased hydrostatic pressure in the pulmonary capillaries after CABG, is increased in the oedematous lungs and has been described in several studies.7-10 Transpulmonary thermodilution technique is used to monitor the cardiac preload volume through the global end-diastolic volume (GEDV) and estimates EVLW volume, which is considered a reliable estimate of interstitial lung oedema.11 Different types of priming fluids were used in CPB circuits to provide organ protection and perfusion.12-14 Crystalloid and colloid priming fluids are still in use, and, to date, no standard solution has gained general acceptance.15,16 Crystalloid-based priming fluids were found to reduce colloid oncotic pressure (COP) and cause CABG-related oedema.17 However, 6% hydroxyethyl starch 130/0.4 (6% HES) as a synthetic colloid can increase the COP.18 Despite all that is known, the effects of the composition of the priming fluid on the outcome parameters, such as EVLW, duration of extubation and intensive care unit (ICU)/hospital stay in CABG remain unclear.13,19,20 The primary aim of this study was to test the hypothesis that colloid priming fluid provides protective effects against oxidative stress and interstitial pulmonary oedema in CABG. As a secondary aim, we compared the short-term outcome parameters. Methods After the study protocol was approved by the ethics committee (ATADEK-723) and written informed consent was obtained from each patient, 30 consecutive patients scheduled for elective CABG were selected for the study. The patients were randomly Department of Anesthesiology and Reanimation, Acıbadem Mehmet Ali Aydınlar University, Altunizade Hospital, Istanbul, Turkey Halim Ulugöl, MD, halimulugol@yahoo.com.tr Meltem Güner Can, MD Fevzi Toraman, MD Department of Biology, Faculty of Science, University of Istanbul, İstanbul, Turkey Uğur Aksu, PhD Kubra Vardar, MSc Department of Cardiovascular Surgery, Acıbadem Mehmet Ali Aydınlar University, Altunizade Hospital, Istanbul, Turkey Murat Ökten, MD
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