CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 2, May – August 2024 AFRICA 73 sub-glycocalyx. In our study, sialic acid, one of the glycocalyx damage markers, was found to be similar in both groups. As a result, EVLWI was similar in patients receiving colloid and crystalloid fluids. In a meta-analysis of 29 studies published in 2022, the strategies of crystalloid and colloid priming were compared.30 The authors emphasised that both priming fluids were similar in terms of COP. Various types of priming fluids have been researched, but no consensus has been reached on the ideal composition to prevent SIRS and fluid extravasation. The literature contains a few studies related to the effects of priming fluids on ELWI. In a previous study by Hoeft et al.,8 the researchers demonstrated that priming with a colloid fluid attenuated the increase in EVLW when compared to the effects of a pure crystalloid priming solution. Similarly, in a study investigating the effects of a hyperoncotic solution on EVLW and pulmonary function, the researchers found that post-CPB, EVLW was unchanged in the HES group, but elevated by 22% in the crystalloid group.19 They also indicated that the colloid solution prevented EVLW accumulation in the early post-pump period. Sade et al.31 designed a study to determine whether there were important differences in the clinical effects of HES, albumin and lactate Ringer’s solution (LRS) when used in priming fluid. They found greater somatic and pulmonary fluid accumulation in the LRS group and suggested that colloid was preferable to crystalloid priming fluids. However, no beneficial effects concerning the clinical parameters and patient outcomes could be demonstrated in the majority of the studies using colloid priming fluids. Our study differs from previous studies in that most prior studies of the effects of different priming fluids on clinical outcomes focused on the impairment of blood coagulation and renal function related to HES usage.32,33 In our study, we evaluated ELWI together with the oxidative stress status, which are the two main mechanisms that contribute to CPB-related organ damage. We have shown that two different priming fluids with similar results in terms of cell integrity and oxidative stress did not increase lung fluid content. Choi et al.34 studied the effects of HES in comparison with human albumin and found no difference in the inflammatory response. Similarly, Lioi et al.35 compared three different priming fluids (lactate Ringer’s solution, human albumin and 10% HES) and found no statistically significant differences between the groups with regard to inflammatory cytokines. In our study, the oxidative stress parameters were similar in both groups. Although there are numerous methods available for the assessment of oxidative stress, AOPP, IMA, fHb and T-SH levels have been proposed as possible markers of redox status. As an inflammatory marker, SA, which is known to have a significant correlation with other plasma acute-phase proteins, such as C-reactive protein and fibrinogen, was chosen.36,37 Neither of the priming fluids used in our study caused detrimental effects on the redox or inflammatory status. As a first limitation of our study, different processes of cellular damage such as apoptosis, inflammation and DNA damage may have taken place in our experimental set-up. However, in order not to spoil the perspective of the study, we only wanted to associate oxidative stress with lung water. The second limitation is that only male subjects should have been included in the study so that hormonal changes did not affect the study. However, to avoid difficulties while generalising the findings, our study was carried out with a mixed-gender population. Conclusion In our study, while the oxidative stress parameters were similar in both groups, mild increases in ELWI that did not reach statistical significance were observed in the crystalloid group. The colloid (6% HES) priming fluid was shown to be similar to the crystalloid fluid in terms of ELWI. Further studies on high-risk patients are warranted to explore the effects of different priming fluids on clinical parameters and patient outcomes. References 1. Levy JH, Tanaka KA. Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg 2003; 75(2): S715–720. 2. Wan S, LeClerc JL, Vincent JL. Inflammatory response to cardiopulmonary bypass: mechanisms involved and possible therapeutic strategies. Chest 1997; 112(3): 676–692. 3. Chenoweth DE, Cooper SW, Hugli TE, Stewart RW, Blackstone EH, Kirklin JW. Complement activation during cardiopulmonary bypass: evidence for generation of C3a and C5a anaphylatoxins. N Engl J Med 1981; 304(9): 497–503. 4. Morita K, Ihnken K, Buckberg GD, Ignarro LJ. Oxidative insult associated with hyperoxic cardiopulmonary bypass in the infantile heart and lung. Jpn Circ J 1996; 60(6): 355–363. 5. Seghaye MC, Grabitz RG, Duchateau J, Busse S, Dabritz S, Koch D, et al. Inflammatory reaction and capillary leak syndrome related to cardiopulmonary bypass in neonates undergoing cardiac operations. J Thorac Cardiovasc Surg 1996; 112(3): 687–697. 6. Chignalia AZ, Yetimakman F, Christiaans SC, Unal S, Bayrakci B, Wagener BM, et al. The glycocalyx and trauma: a review. Shock 2016; 45(4): 338–348. 7. Hachenberg T, Tenling A, Rothen HU, Nystrom SO, Tyden H, Hedenstierna G. Thoracic intravascular and extravascular fluid volumes in cardiac surgical patients. Anesthesiology 1993; 79(5): 976–984. 8. Hoeft A, Korb H, Mehlhorn U, Stephan H, Sonntag H. Priming of cardiopulmonary bypass with human albumin or Ringer lactate: effect on colloid osmotic pressure and extravascular lung water. Br J Anaesth 1991; 66(1): 73–80. 9. Boldt J, Bormann BV, Kling D, Scheld H, Hempelmann G. Influence of acute normovolemic hemodilution on extravascular lung water in cardiac surgery. Crit Care Med 1988; 16(4): 336–339. 10. Jin X, Chen Z, Wang M, Lu W, Zhang W, Sun J. [Effects of hyperoncotic cardiopulmonary bypass prime on extravascular lung water and cardiopulmonary function in patients undergoing coronary artery bypass surgery]. Zhonghua Yi Xue Za Zhi 2014; 94(9): 646–650. 11. Monnet X, Teboul JL. Transpulmonary thermodilution: advantages and limits. Crit Care 2017; 21(1): 147. 12. Mehlhorn U, Allen SJ, Davis KL, Geissler HJ, Warters RD, Rainer de Vivie E. Increasing the colloid osmotic pressure of cardiopulmonary bypass prime and normothermic blood cardioplegia minimizes myocardial oedema and prevents cardiac dysfunction. Cardiovasc Surg 1998; 6(3): 274–281. 13. Jansen PG, te Velthuis H, Wildevuur WR, Huybregts MA, Bulder ER, van der Spoel HI, et al. Cardiopulmonary bypass with modified fluid gelatin and heparin-coated circuits. Br J Anaesth 1996; 76(1): 13–19. 14. Buhre W, Hoeft A, Schorn B, Weyland A, Scholz M, Sonntag H. Acute affect of mitral valve replacement on extravascular lung water in patients
RkJQdWJsaXNoZXIy NDIzNzc=