CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 2, May – August 2024 72 AFRICA For the colloid group, the fHb levels (g/l) were measured as 0.08 ± 0.02 at T0, 0.19 ± 0.04 at T5 and 0.06 ± 0.01 at T7. For the crystalloid group, the fHb levels (g/l) were measured as 0.14 ± 0.03 at T1, 0.24 ± 0.06 at T5 and 0.08 ± 0.04 at T7. For the colloid group, the SA levels (mg/g protein) were measured as 0.38 ± 0.03 at T1, 0.55 ± 0.06 at T5 and 0.66 ± 0.08 at T7. For the crystalloid group, the SA levels (mg/g protein) were measured as 0.48 ± 0.06 at T1, 0.56 ± 0.06 at T5 and 0.69 ± 0.09 at T7. No significant differences in oxidative stress and cellular injury parameters were found between the colloid and crystalloid group at any time (Table 2) (p > 0.05). The changes in all PiCCO parameters are presented in Table 3. There was no significant difference between the groups (p > 0.05). ELWI (ml/kg) was measured as 11.7 ± 1.6 (T1), 11.8 ± 1.3 (T4), 10.6 ± 1.2 (T5), 8.5 ± 0.7 (T6) and 9.4 ± 1.1 (T7) in group 1 and as 8.4 ± 0.7 (T1), 9.5 ± 1.2 (T4), 8.6 ± 0.7 (T5), 7.7 ± 1.0 (T6) and 7.3 ± 0.6 (T7) in group 2. No significant differences were found between the two groups (p > 0.05). The ELWI course at the different time points is presented in Fig. 1. Discussion In this study, we compared two different priming fluids for EVLW, oxidative stress, cell integrity and ICU/hospital length of stay during CABG. A minimal increase in EVLW that did not reach statistical significance was observed in the crystalloid priminge fluid compared to the colloid priming fluid at all time points. Colloid and crystalloid priming fluids were also similar in their effects on cell integrity and oxidative stress. Furthermore, there were no differences between the groups in terms of postoperative ventilation times and length of ICU or hospital stay. Performing coronary revascularisation using the CPB technique is an effective and safe technique, but fluidaccumulation in the extravascular space is a phenomenon associated with the CPB technique.27 Fluid extravasation leads to increased water content in the tissues, which results in cardiac and pulmonary dysfunction. The mechanisms contributing to this fluid shift are complex and attributed to a decrease in plasma oncotic pressure with the use of priming fluids during CPB, SIRS secondary to the exposure of blood to foreign surfaces, hypothermia or ischaemia–reperfusion injury. This study was undertaken primarily to investigate changes in EVLW and oxidative stress status when different types of priming fluids were used for CPB. It was hypothesised that the crystalloid priming group (group 2) would have higher levels of ELWI, which would have apparent clinical effects, while the colloid priming fluid was expected to have beneficial effects during the peri-operative period. It was previously believed that transcapillary fluid shift is determined solely by the balance between hydrostatic pressure and COP.28 However, the revised Starling equation, which has been accepted in recent years, has changed the view on fluid balance.29 According to this equation, fluid movement from the intravascular space to the tissue is less affected by COP. The most important factor determining transcapillary fluid movement is the endothelial glycocalyx layer and the COP in the Table 2. Time-dependent changes in oxidative stress and cellular injury parameters in the two groups Time Group IMA (ABS units) T-SH (umol/g protein) AOPP (mmol/g protein) fHb (g/l) SA (mg/g protein) T1 G1 G2 0.511 ± 0.047 0.388 ± 0.074 33.6 ± 2.1 39.2 ± 4.1 24.5 ± 2.2 34.0 ± 3.8 0.08 ± 0.02 0.14 ± 0.03 0.38 ± 0.03 0.48 ± 0.06 T5 G1 G2 0.475 ± 0.059 0.355 ± 0.063 76.7 ± 10.4 55.3 ± 5.8 34.9 ± 3.4 42.1 ± 6.0 0.19 ± 0.04 0.24 ± 0.06 0.55 ± 0.06 0.56 ± 0.06 T7 G1 G2 0.457 ± 0.055 0.424 ± 0.080 77.7 ± 20.7 64.1 ± 6.7 30.6 ± 3.8 37.4 ± 4.8 0.06 ± 0.01 0.08 ± 0.04 0.66 ± 0.08 0.69 ± 0.09 IMA, ischaemic modified albumin; T-SH, total thiol; AOPP, advanced oxidative protein products; fHb, free haemoglobin; SA, sialic acid. Table 3. Time-dependent parameters measured with PiCCO technology in the two groups Time Group PiCCO CI (l/min/m2) PiCCO SVI (ml/m2) PiCCO GEDI (ml/m2) PiCCO GEF (%) PiCCO ELWI (ml/kg) T1 G1 G2 2.3 ± 0.2 2.1 ± 0.1 33.3 ± 3.4 29.3 ± 2.8 642 ± 61 628 ± 33 20.0 ± 2.2 21.0 ± 1.4 11.7 ± 1.6 8.4 ± 0.7 T4 G1 G2 2.3 ± 0.3 2.4 ± 0.2 26.6 ± 1.7 31.2 ± 2.0 717 ± 84 614 ± 31 16.6 ± 2.1 23.2 ± 1.6 11.8 ± 1.3 9.5 ± 1.2 T5 G1 G2 2.4 ± 0.2 2.3 ± 0.1 27.5 ± 2.9 29.2 ± 1.0 749 ± 83 607 ± 90 17.6 ± 2.6 21.3 ± 0.8 10.6 ± 1.2 8.6 ± 0.7 T6 G1 G2 2.6 ± 0.2 2.5 ± 0.1 27.6 ± 2.8 26.0 ± 1.3 711 ± 81 639 ± 50 17.0 ± 2.6 19.4 ± 1.6 8.5 ± 0.7 7.7 ± 1.0 T7 G1 G2 3.0 ± 0.1 2.9 ± 0.2 33.9 ± 1.8 34.5 ± 2.2 848 ± 28 698 ± 48 18.5 ± 2.0 19.7 ± 0.9 9.4 ± 1.1 7.3 ± 0.6 PiCCO, pulse index contour continuous cardiac output; CI, cardiac index; SVI, stroke volume index; GEDI, global end-diastolic index; GEF, global ejection fraction; ELWI, extravascular lung water index. ELWI (ml/kg) Priming fluids t1 t4 t5 t6 t7 15 10 5 0 Crystaloid Colloid Fig. 1. Time-dependent changes in ELWI (ml/kg) in the two groups. ELWI, extravascular lung water index. Table 1. Haemodynamic, biochemical and arterial blood gas measurements in the two groups Time Grp HR (beats/min) MAP (mmHg) pCO2 (mmHg) pO2 (mmHg) Haematocrit (%) Glucose (mg/dl) Lactate (mmol/l) T1 G1 G2 62.2 ± 4.0 57.0 ± 3.0 74.1 ± 3.0 80.3 ± 4.0 36.0 ± 0.7 36.5 ± 1.3 159.4 ± 4.0 179.2 ± 10.2 36.1 ± 2.1 40.0 ± 1.5 129.4 ± 15.3 116.6 ± 6.8 1.2 ± 0.1 1.5 ± 0.2 T4 G1 G2 80.5 ± 4.0 74.7 ± 4.0 69.5 ± 2.0 67.0 ± 2 35.5 ± 0.9 36.2 ± 0.9 123.8 ± 12.9 113.7 ± 6.5 29.0 ± 1.8 27.1 ± 1.0 165.2 ± 18.6 139.7 ± 10.7 1.8 ± 0.3 1.8 ± 0.2 T5 G1 G2 85.5 ± 6.0 77.7 ± 2.0 88.8 ± 4.0 77.0 ± 5.0 33.4 ± 1.0 31.7 ± 1.1 135.2 ± 13.6 118.8 ± 10.1 31.7 ± 1.2 29.6 ± 1.1 166.5 ± 17.0 142.6 ± 12.0 1.7 ± 0.3 1.9 ± 0.2 T6 G1 G2 93.8 ± 4.0 94.9 ± 4.0 79.0 ± 3.0 76.4 ± 3.0 34.6 ± 1.1 34.3 ± 1.7 131.8 ± 8.5 149.7 ± 7.6 33.1 ± 1.3 31.8 ± 1.1 163.9 ± 10.5 144.9 ± 11.3 2.3 ± 0.3 2.3 ± 0.3 T7 G1 G2 87.5 ± 3.0 83.9 ± 4.0 83.1 ± 3.0 82.2 ± 3.0 36.4 ± 1.0 38.4 ± 0.9 96.0 ± 6.6 99.8 ± 6.7 29.9 ± 1.3 30.0 ± 1.0 175.0 ± 10.5 183.5 ± 7.0 2.0 ± 0.4 2.2 ± 0.3 HR, heart rate; MAP, mean arterial pressure; pCO2, partial pressure of carbon dioxide; pO2, partial pressure of oxygen.
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