Document Detail


Intra-operative intravenous fluid restriction reduces perioperative red blood cell transfusion in elective cardiac surgery, especially in transfusion-prone patients: a prospective, randomized controlled trial.
MedLine Citation:
PMID:  20181257     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Cardiac surgery is a major consumer of blood products, and hemodilution increases transfusion requirements during cardiac surgery under CPB. As intraoperative parenteral fluids contribute to hemodilution, we evaluated the hypothesis that intraoperative fluid restriction reduces packed red-cell (PRC) use, especially in transfusion-prone adults undergoing elective cardiac surgery.
METHODS: 192 patients were randomly assigned to restrictive (group A, 100 pts), or liberal (group B, 92 pts) intraoperative intravenous fluid administration. All operations were conducted by the same team (same surgeon and perfusionist). After anesthesia induction, intravenous fluids were turned off in Group A (fluid restriction) patients, who only received fluids if directed by protocol. In contrast, intravenous fluid administration was unrestricted in group B. Transfusion decisions were made by the attending anesthesiologist, based on identical transfusion guidelines for both groups.
RESULTS: 137 of 192 patients received 289 PRC units in total. Age, sex, weight, height, BMI, BSA, LVEF, CPB duration and surgery duration did not differ between groups. Fluid balance was less positive in Group A. Fewer group A patients (62/100) required transfusion compared to group B (75/92, p < 0.04). Group A patients received fewer PRC units (113) compared to group B (176; p < 0.0001). Intraoperatively, the number of transfused units and transfused patients was lower in group A (31 u in 19 pts vs. 111 u in 62 pts; p < 0.001). Transfusions in ICU did not differ significantly between groups. Transfused patients had higher age, lower weight, height, BSA and preoperative hematocrit, but no difference in BMI or discharge hematocrit. Group B (p < 0.005) and female gender (p < 0.001) were associated with higher transfusion probability. Logistic regression identified group and preoperative hematocrit as significant predictors of transfusion.
CONCLUSIONS: Our data suggest that fluid restriction reduces intraoperative PRC transfusions without significantly increasing postoperative transfusions in cardiac surgery; this effect is more pronounced in transfusion-prone patients.
TRIAL REGISTRATION: NCT00600704, at the United States National Institutes of Health.
Authors:
George Vretzakis; Athina Kleitsaki; Konstantinos Stamoulis; Metaxia Bareka; Stavroula Georgopoulou; Menelaos Karanikolas; Athanasios Giannoukas
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial     Date:  2010-02-24
Journal Detail:
Title:  Journal of cardiothoracic surgery     Volume:  5     ISSN:  1749-8090     ISO Abbreviation:  J Cardiothorac Surg     Publication Date:  2010  
Date Detail:
Created Date:  2010-03-26     Completed Date:  2010-05-18     Revised Date:  2013-05-30    
Medline Journal Info:
Nlm Unique ID:  101265113     Medline TA:  J Cardiothorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  7     Citation Subset:  IM    
Affiliation:
Cardiac Anesthesia Unit, Department of Anesthesiology, University Hospital of Larissa, Greece.
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00600704
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MeSH Terms
Descriptor/Qualifier:
Aged
Blood Loss, Surgical
Cardiac Surgical Procedures*
Chi-Square Distribution
Erythrocyte Transfusion*
Female
Hemodilution / adverse effects*
Humans
Infusions, Intravenous / adverse effects*
Intraoperative Care
Logistic Models
Male
Middle Aged
Prospective Studies
Statistics, Nonparametric
Treatment Outcome
Comments/Corrections

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