Prolonged Cardiovascular Pharmacological Support and Fluid Management After Cardiac Surgery

Loay Kontar, William Beaubien-Souligny, Etienne J. Couture, Matthias Jacquet-Lagrèze, Yoan Lamarche, Sylvie Levesque, Denis Babin, André Y. Denault.

Abstract

To identify potentially modifiable risk factors related to prolonged cardiovascular pharmacological support after weaning from cardiopulmonary bypass (CPB).

Introduction

Hemodynamic instability is a frequent complication after cardiopulmonary bypass (CPB) separation and can lead to significant morbidity and mortality that worsen postoperative clinical outcomes. Vasoplegia syndrome (VS) and low cardiac output syndrome (LCOS) are the most common causes of prolonged cardiovascular pharmacological support after weaning from CPB.

Materials and Methods:

Study setting and patient selection

Patient data was collected from two observational prospective studies conducted between August 2016 and July 2017, in which repeated echocardiographic evaluation including intraoperative transesophageal echocardiography (TEE) and postoperative bedside transthoracic echocardiography were performed.

Data sources

Data including laboratory tests, surgical and anesthetic variables as well as drug dosages were retrieved from the electronic patient record and the electronic preoperative anesthesia record (CompuRecord, Philips, Netherlands).

Definitions

Prolonged cardiovascular pharmacological support was defined as the need for at least one vasopressor or one inotropic agent from the end of CPB for a duration greater than 24 hours which prevent discharge from the intensive care unit (ICU).

Discussion

In this cohort of cardiac surgical patients, we found that preexisting severe LV systolic dysfunction, preoperative PH and postoperative fluid overload were independently associated with prolonged cardiovascular pharmacological support after cardiac surgery with CPB. The resulting model reliably identified patients who had prolonged cardiovascular pharmacological support within the studied sample.

Citation: Kontar L, Beaubien-Souligny W, Couture EJ, Jacquet-Lagrèze M, Lamarche Y, Levesque S, et al. (2023) Prolonged cardiovascular pharmacological support and fluid management after cardiac surgery. PLoS ONE 18(5): e0285526. https://doi.org/10.1371/journal.pone.0285526

Editor: Redoy Ranjan, BSMMU: Bangabandhu Sheikh Mujib Medical University, BANGLADESH

Received: October 3, 2022; Accepted: April 25, 2023; Published: May 11, 2023.

Copyright: © 2023 Kontar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: Patient data contain potentially identifying and/or confidential sensitive patient information, therefore, are not publicly available but can be accessed by researchers who meet criteria for accesses to sensitive data under the Montreal Heart Institute Research Ethics terms. For further information, contact: cer.icm@icm-mhi.org.

Funding: This work was supported by the Montreal Heart Institute Foundation and the Richard I. Kaufman Endowment Fund in Anesthesia and Critical Care, Montreal. All the funding sources had no involvement in this study. There was no additional external funding received for this study. This confirms that the funders provided support in the form of salaries, equipment, drugs and/or supplies for the author (AYD), but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific role of this author is articulated in the ‘author contributions’ section.

Competing interests: Dr. Denault is on the Speakers Bureau for CAE Healthcare (2010), Masimo (2017) and Edwards (2019). No other conflict of interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Abbreviations: AKI, acute kidney injury; CFB, cumulative fluid balance; CPB, cardiopulmonary bypass; ICU, intensive care unit; IQR, interquartile range; LCOS, low cardiac output syndrome; LOESS, locally estimated scatterplot smoothing; LV, left ventricular; LVEF, left ventricular ejection fraction; PAP, pulmonary artery pressure; pEEG, processed electroencephalogram; PH, pulmonary hypertension; RV, right ventricular; SD, standard deviation; TEE, transesophageal echocardiography; VS, vasoplegic syndrome.