Fluid overload after coronary artery bypass graft in patients on maintenance hemodialysis is associated with prolonged time on mechanical ventilation
Abstract Background Fluid overload is a risk factor for morbidity, mortality, and prolonged ventilation time after surgery. Patients on maintenance hemodialysis might be at higher risk. We hypothesized that fluid accumulation would be directly associated with extended ventilation time in patients on...
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| Format: | Article |
| Language: | English |
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BMC
2020-03-01
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| Series: | BMC Anesthesiology |
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| Online Access: | http://link.springer.com/article/10.1186/s12871-020-00971-6 |
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| author | Sirlei Cristina da Silva Fernanda Marciano Consolim-Colombo Renata Gomes Rodrigues Fábio Antonio Gaiotto Ludhmila Abrahão Hajjar Rosa Maria Affonso Moysés Rosilene Motta Elias |
| author_facet | Sirlei Cristina da Silva Fernanda Marciano Consolim-Colombo Renata Gomes Rodrigues Fábio Antonio Gaiotto Ludhmila Abrahão Hajjar Rosa Maria Affonso Moysés Rosilene Motta Elias |
| author_sort | Sirlei Cristina da Silva |
| collection | DOAJ |
| description | Abstract Background Fluid overload is a risk factor for morbidity, mortality, and prolonged ventilation time after surgery. Patients on maintenance hemodialysis might be at higher risk. We hypothesized that fluid accumulation would be directly associated with extended ventilation time in patients on hemodialysis, as compared to patients with chronic kidney disease not on dialysis (CKD3–4) and patients with normal renal function (reference group). Methods This is a prospective observational study that included patients submitted to isolated and elective coronary artery bypass surgery, divided in 3 groups according to time on mechanical ventilation: < 24 h, 24-48 h and > 48 h. The same observer followed patients daily from the surgery to the hospital discharge. Cumulative fluid balance was defined as the sum of daily fluid balance over the first 5 days following surgery. Results Patients requiring more than 48 h of ventilation (5.3%) had a lower estimated glomerular filtration rate, were more likely to be on maintenance dialysis, had longer anesthesia time, needed higher dobutamine and noradrenaline infusion following surgery, and had longer hospitalization stay. Multivariate analysis revealed that the fluid accumulation, scores of sequential organ failure assessment in the day following surgery, and the renal function (normal, chronic kidney disease not on dialysis and maintenance hemodialysis) were independently associated with time in mechanical ventilation. Among patients on hemodialysis, the time from the surgery to the first hemodialysis session also accounted for the time on mechanical ventilation. Conclusions Fluid accumulation is an important risk factor for lengthening mechanical ventilation, particularly in patients on hemodialysis. Future studies are warranted to address the ideal timing for initiating dialysis in this scenario in an attempt to reduce fluid accumulation and avoid prolonged ventilation time and hospital stay. |
| first_indexed | 2024-12-12T13:39:27Z |
| format | Article |
| id | doaj.art-d2c5fa786fe347eb8994835612c485fb |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-12-12T13:39:27Z |
| publishDate | 2020-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-d2c5fa786fe347eb8994835612c485fb2022-12-22T00:22:51ZengBMCBMC Anesthesiology1471-22532020-03-012011810.1186/s12871-020-00971-6Fluid overload after coronary artery bypass graft in patients on maintenance hemodialysis is associated with prolonged time on mechanical ventilationSirlei Cristina da Silva0Fernanda Marciano Consolim-Colombo1Renata Gomes Rodrigues2Fábio Antonio Gaiotto3Ludhmila Abrahão Hajjar4Rosa Maria Affonso Moysés5Rosilene Motta Elias6Instituto do Coração, Hospital das Clinicas HCFMUSP, Universidade de São PauloInstituto do Coração, Hospital das Clinicas HCFMUSP, Universidade de São PauloUniversidade Nove de Julho (UNINOVE)Instituto do Coração, Hospital das Clinicas HCFMUSP, Universidade de São PauloInstituto do Coração, Hospital das Clinicas HCFMUSP, Universidade de São PauloNephrology, Hospital das Clinicas HCFMUSP, Universidade de São PauloNephrology, Hospital das Clinicas HCFMUSP, Universidade de São PauloAbstract Background Fluid overload is a risk factor for morbidity, mortality, and prolonged ventilation time after surgery. Patients on maintenance hemodialysis might be at higher risk. We hypothesized that fluid accumulation would be directly associated with extended ventilation time in patients on hemodialysis, as compared to patients with chronic kidney disease not on dialysis (CKD3–4) and patients with normal renal function (reference group). Methods This is a prospective observational study that included patients submitted to isolated and elective coronary artery bypass surgery, divided in 3 groups according to time on mechanical ventilation: < 24 h, 24-48 h and > 48 h. The same observer followed patients daily from the surgery to the hospital discharge. Cumulative fluid balance was defined as the sum of daily fluid balance over the first 5 days following surgery. Results Patients requiring more than 48 h of ventilation (5.3%) had a lower estimated glomerular filtration rate, were more likely to be on maintenance dialysis, had longer anesthesia time, needed higher dobutamine and noradrenaline infusion following surgery, and had longer hospitalization stay. Multivariate analysis revealed that the fluid accumulation, scores of sequential organ failure assessment in the day following surgery, and the renal function (normal, chronic kidney disease not on dialysis and maintenance hemodialysis) were independently associated with time in mechanical ventilation. Among patients on hemodialysis, the time from the surgery to the first hemodialysis session also accounted for the time on mechanical ventilation. Conclusions Fluid accumulation is an important risk factor for lengthening mechanical ventilation, particularly in patients on hemodialysis. Future studies are warranted to address the ideal timing for initiating dialysis in this scenario in an attempt to reduce fluid accumulation and avoid prolonged ventilation time and hospital stay.http://link.springer.com/article/10.1186/s12871-020-00971-6HemodialysisIntensive care unitRenal diseaseDialysisChronic kidney disease |
| spellingShingle | Sirlei Cristina da Silva Fernanda Marciano Consolim-Colombo Renata Gomes Rodrigues Fábio Antonio Gaiotto Ludhmila Abrahão Hajjar Rosa Maria Affonso Moysés Rosilene Motta Elias Fluid overload after coronary artery bypass graft in patients on maintenance hemodialysis is associated with prolonged time on mechanical ventilation BMC Anesthesiology Hemodialysis Intensive care unit Renal disease Dialysis Chronic kidney disease |
| title | Fluid overload after coronary artery bypass graft in patients on maintenance hemodialysis is associated with prolonged time on mechanical ventilation |
| title_full | Fluid overload after coronary artery bypass graft in patients on maintenance hemodialysis is associated with prolonged time on mechanical ventilation |
| title_fullStr | Fluid overload after coronary artery bypass graft in patients on maintenance hemodialysis is associated with prolonged time on mechanical ventilation |
| title_full_unstemmed | Fluid overload after coronary artery bypass graft in patients on maintenance hemodialysis is associated with prolonged time on mechanical ventilation |
| title_short | Fluid overload after coronary artery bypass graft in patients on maintenance hemodialysis is associated with prolonged time on mechanical ventilation |
| title_sort | fluid overload after coronary artery bypass graft in patients on maintenance hemodialysis is associated with prolonged time on mechanical ventilation |
| topic | Hemodialysis Intensive care unit Renal disease Dialysis Chronic kidney disease |
| url | http://link.springer.com/article/10.1186/s12871-020-00971-6 |
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