The pressure field as a methodology for fluid management and red cell preservation during cardiac surgery
Abstract Purpose Anemia and red cell transfusion contribute to morbidity and mortality of surgery. The concept of patient blood management to mitigate preoperative anemia, optimize coagulation, conserve red cells intraoperatively and accept lower post-operative transfusion thresholds has recently ga...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-01-01
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| Series: | Journal of Cardiothoracic Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13019-023-02134-3 |
| _version_ | 1797945716511866880 |
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| author | Stephen F. Woodford Mark Butlin Bai Wei Wei Chao Alberto Avolio |
| author_facet | Stephen F. Woodford Mark Butlin Bai Wei Wei Chao Alberto Avolio |
| author_sort | Stephen F. Woodford |
| collection | DOAJ |
| description | Abstract Purpose Anemia and red cell transfusion contribute to morbidity and mortality of surgery. The concept of patient blood management to mitigate preoperative anemia, optimize coagulation, conserve red cells intraoperatively and accept lower post-operative transfusion thresholds has recently gained widespread acceptance across a range of surgical disciplines. Fluid administration is likely to contribute significantly to perioperative anemia and red-cell transfusion requirements, yet a robust basis for managing fluid administration in this context has not been articulated. There is an urgent need for this. Methods We developed ‘the pressure field method’ as a novel approach to guiding the administration of fluid and drugs to optimize tissue perfusion. The pressure field method was used for the intraoperative management of 67 patients undergoing semi-elective cardiac surgery. We compared intraoperative anemia and transfusion requirements in this cohort with a conventional group of 413 patients undergoing cardiac surgery. Results In the pressure field group, no patients required transfusion whereas in the conventional group, 16% required transfusion during bypass and these patients received an average of 2.4 units of packed red cells (P < 0.0001). The average decrease in hemoglobin in the pressure field group was only 13 g/L, whereas in the conventional group it was 52 g/L (P < 0.0001). 80% of the pressure field group received no intravenous fluid during cardiac surgery, and the average intraoperative fluid load was 115 mL. Conclusion The pressure field method appears to reduce transfusion requirements due to decreased intraoperative fluid loading. |
| first_indexed | 2024-04-10T20:59:30Z |
| format | Article |
| id | doaj.art-0d6c5cf48915494481d4d06fb0d576b6 |
| institution | Directory Open Access Journal |
| issn | 1749-8090 |
| language | English |
| last_indexed | 2024-04-10T20:59:30Z |
| publishDate | 2023-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Cardiothoracic Surgery |
| spelling | doaj.art-0d6c5cf48915494481d4d06fb0d576b62023-01-22T12:24:49ZengBMCJournal of Cardiothoracic Surgery1749-80902023-01-0118111010.1186/s13019-023-02134-3The pressure field as a methodology for fluid management and red cell preservation during cardiac surgeryStephen F. Woodford0Mark Butlin1Bai Wei2Wei Chao3Alberto Avolio4Department of Anesthesia, Austin HealthFaculty of Medicine, Health and Human Sciences, Macquarie Medical School, Macquarie UniversityBeijing Technology and Business UniversityShanghai Tongji UniversityFaculty of Medicine, Health and Human Sciences, Macquarie Medical School, Macquarie UniversityAbstract Purpose Anemia and red cell transfusion contribute to morbidity and mortality of surgery. The concept of patient blood management to mitigate preoperative anemia, optimize coagulation, conserve red cells intraoperatively and accept lower post-operative transfusion thresholds has recently gained widespread acceptance across a range of surgical disciplines. Fluid administration is likely to contribute significantly to perioperative anemia and red-cell transfusion requirements, yet a robust basis for managing fluid administration in this context has not been articulated. There is an urgent need for this. Methods We developed ‘the pressure field method’ as a novel approach to guiding the administration of fluid and drugs to optimize tissue perfusion. The pressure field method was used for the intraoperative management of 67 patients undergoing semi-elective cardiac surgery. We compared intraoperative anemia and transfusion requirements in this cohort with a conventional group of 413 patients undergoing cardiac surgery. Results In the pressure field group, no patients required transfusion whereas in the conventional group, 16% required transfusion during bypass and these patients received an average of 2.4 units of packed red cells (P < 0.0001). The average decrease in hemoglobin in the pressure field group was only 13 g/L, whereas in the conventional group it was 52 g/L (P < 0.0001). 80% of the pressure field group received no intravenous fluid during cardiac surgery, and the average intraoperative fluid load was 115 mL. Conclusion The pressure field method appears to reduce transfusion requirements due to decreased intraoperative fluid loading.https://doi.org/10.1186/s13019-023-02134-3HemodynamicsFluid therapyPatient blood managementTransfusion |
| spellingShingle | Stephen F. Woodford Mark Butlin Bai Wei Wei Chao Alberto Avolio The pressure field as a methodology for fluid management and red cell preservation during cardiac surgery Journal of Cardiothoracic Surgery Hemodynamics Fluid therapy Patient blood management Transfusion |
| title | The pressure field as a methodology for fluid management and red cell preservation during cardiac surgery |
| title_full | The pressure field as a methodology for fluid management and red cell preservation during cardiac surgery |
| title_fullStr | The pressure field as a methodology for fluid management and red cell preservation during cardiac surgery |
| title_full_unstemmed | The pressure field as a methodology for fluid management and red cell preservation during cardiac surgery |
| title_short | The pressure field as a methodology for fluid management and red cell preservation during cardiac surgery |
| title_sort | pressure field as a methodology for fluid management and red cell preservation during cardiac surgery |
| topic | Hemodynamics Fluid therapy Patient blood management Transfusion |
| url | https://doi.org/10.1186/s13019-023-02134-3 |
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