Conventional hemofiltration during cardiopulmonary bypass increases the serum lactate level in adult cardiac surgery.
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Date
2016-01
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Abstract
Objective: To evaluate the effect of hemofiltration during cardiopulmonary bypass on lactate level in adult
patients who underwent cardiac surgery. Design: An observational study. Setting: Prince Sultan cardiac center,
Riyadh, Saudi Arabia. Participants: The study included 283 patients classified into two groups: Hemofiltration
group (n=138), hemofiltration was done during CPB. Control group (n = 145), patients without hemofiltration.
Interventions: Hemofiltration during cardiopulmonary bypass. Measurements and Main Results: Monitors
included hematocrit, lactate levels, mixed venous oxygen saturation, amount of fluid removal during
hemofiltration and urine output. The lactate elevated in group H than group C (P < 0.05), and the PH showed
metabolic acidosis in group H (P < 0.05). The mixed venous oxygen saturation decreased in group H than
group C (P < 0.05). The number of transfused packed red blood cells was lower in group H than group C
(P < 0.05). The hematocrit was higher in group H than group C (P < 0.05). The urine output was lower in
group H than group C (P < 0.05). Conclusions: Hemofiltration during cardiopulmonary bypass leads to
hemoconcentration, elevated lactate level and increased inotropic support. There are some recommendations
for hemofiltration: First; Hemofiltration should be limited for patients with impaired renal function, positive
fluid balance, reduced response to diuretics or prolonged bypass time more than 2 hours. Second; Minimal
amount of fluids should be administered to maintain adequate cardiac output and reduction of priming
volumes is preferable to maintain controlled hemodilution. Third; it should be done before weaning of or
after cardiopulmonary bypass and not during the whole time of cardiopulmonary bypass.
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Keywords
Cardiac surgery, Cardiopulmonary bypass, Hematocrit, Hemofiltration, Lactate
Citation
Soliman Rabie, Fouad Eman, Belghith Makhlouf, Abdelmageed Tarek. Conventional hemofiltration during cardiopulmonary bypass increases the serum lactate level in adult cardiac surgery. Annals of Cardiac Anaesthesia. 2016 Jan; 19(1): 45-51.