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Vol. 96, No. 3-4, 2001
Issue release date: 2001
Cardiology 2001;96:169–176

Intensive Care Unit Management of the Critically Ill Patient with Fluid Overload after Open Heart Surgery

Bellomo R. · Raman J. · Ronco C.
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Fluid overload is common before, during and after cardiac surgery. The fluid associated with cardiopulmonary bypass (CPB) and cardioplegia is a particularly important source of such fluid overload. In addition, renal dysfunction, which is common in these patients, participates in the pathogenesis of a positive sodium and water balance. Such fluid overload is physiologically undesirable and participates in the pathogenesis of several clinically important complications. Fluid overload can be partly prevented with the use of diuretics. However, in many patients, diuretics do not achieve sufficient sodium and water diuresis. In these patients, the application of hemofiltration (HF) during CPB and also immediately after CPB is an effective and safe approach to the maintenance of fluid homeostasis. If acute renal failure occurs, early intervention with HF may even improve survival.

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  1. Cipolla CM, Grazi S, Rimondini A, Susini G, Guazzi M, Della Bella P, Guazzi MD: Changes in circulating norepinephrine with hemofiltration in advanced congestive cardiac failure. Am J Cardiol 1990;66:987–994.
  2. Donato L, Biagini A, Contini C, L’Abbate A, Emdin M, Piacenti M, Palla R: Treatment of end-stage congestive heart failure by extracorporeal ultrafiltration. Am J Cardiol 1987;59:379–380.

    External Resources

  3. Marenzi G, Grazi S, Giraldi F, Lauri G, Perego G, Guazzi M, Salvioni A, Guazzi MD: Interrelation of humoral factors, hemodynamics, and fluid and salt metabolism in congestive heart failure: Effects of extracorporeal ultrafiltration. Am J Med 1993;94:49–56.
  4. Boyle EM Jr, Pohlman TH, Johnson MC, Verrier ED: Endothelial cell injury in cardiovascular surgery: The systemic inflammatory response. Ann Thorac Surg 1997;63:277–284.
  5. Naik SK, Knight A, Elliott M: A prospective randomized study of a modified technique of ultrafiltration during pediatric open-heart surgery. Circulation 1991;84(5 suppl):III422–III431.
  6. Naik SK, Elliott M: Ultrafiltration and pediatric cardiopulmonary bypass. Perfusion 1993;8:101–112.
  7. Elliott MJ: Ultrafiltration and modified ultrafiltration in pediatric open heart operations. Ann Thorac Surg 1993;56:1518–1522.
  8. Cooper JD, Maeda M, Lowenstein E: Lung water accumulation with acute hemodilution in dogs. J Thorac Cardiovasc Surg 1975;69:957–965.

    External Resources

  9. Millar AB, Armstrong L, van der Linden J, Moat N, Ekroth R, Westwick J, Scallan M, Lincoln C: Cytokine production and hemofiltration in children undergoing cardiopulmonary bypass. Ann Thorac Surg 1993;56:1499–1502.
  10. Howard RJ, Crain C, Franzini DA, Hood CI, Hugli TE: Effects of cardiopulmonary bypass on pulmonary leukostasis and complement activation. Arch Surg 1988;123:496–501.
  11. Koutlas TG, Gaynor JW, Nicolson SC, Steven JM, Wernovsky G, Spray TL: Modified ultrafiltration reduces post-operative morbidity after cavopulmonary connection. Ann Thorac Surg 1997;64:37–43.
  12. Journois D, Pouard P, Greeley WJ, Mauriat P, Vohue P, Safran D: Hemofiltration during cardiopulmonary bypass in pediatric cardiac surgery. Effects on hemostasis, cytokines and complement components. Anesthesiology 1994;81:1181–1189, discussion 26A–27A.
  13. Myles PS, Buckland MR, Schenk NJ, Cannon GB, Langley M, Davis BB, Weeks AM: Effect of ‘renal-dose’ dopamine on renal function following cardiac surgery. Anaesth Intensive Care 1993;21:56–61.
  14. Bellomo R, Chapman M, Finfer S, Hickling K, Myburgh J: Low-dose dopamine in patients with early renal dysfunction: A placebo-controlled randomised trial. Australian and New Zealand Intensive Care Society (ANZICS) Clinical Trials Group. Lancet 2000;356:2139–2143.
  15. Berendes E, Mollhoff T, van Aken H, Schmidt C, Erren M, Deng MC, Weyand M, Loick HM: Effects of dopexamine on creatinine clearance, systemic inflammation and splanchnic oxygenation in patients undergoing coronary artery bypass grafting. Anesth Analg 1997;84:950–957.
  16. Meyer M, Wiebe K, Wahlers T, Zenker D, Schulze FP, Michaels P, Forssmann WG: Urodilatin (INN:ularitide) as a new drug for the therapy of acute renal failure following cardiac surgery. Clin Exp Pharmacol Physiol 1997;24:374–376.
  17. Meyer M, Pfarr E, Schirmer G, Überbacher HJ, Schope K, Böhm E. Flüge T, Mentz P, Scigalla P, Forssmann W-G: Therapeutic use of natriuretic peptide ularitide in acute renal failure. Ren Fail 1999;21:85–100.
  18. French C, Bellomo R: The role of α-receptor manipulation in the prevention of renal dysfunction. Curr Opin Crit Care 1997;3:408–413.
  19. Bersten A, Holt A: Hemodynamic factors influencing renal blood flow; in Ronco C, Bellomo R (eds): Critical Care Nephrology. Dordrecht, Kluwer Academic, 1998, pp 599–612.
  20. Bellomo R, Kellum J, Wisniewski S, Pinsky MR: Effects of norepinephrine on the renal vasculature in normal and endotoxemic dogs. Am J Respir Crit Care Med 1999;159:1186–1191.

    External Resources

  21. Silvester W, Bellomo R, Ronco C: Continuous versus intermittent renal replacement therapy in the critically ill; in Ronco C, Bellomo R (eds): Critical Care Nephrology. Dordrecht, Kluwer Academic, 1998, pp 1225–1238.
  22. Glenn TM, Lefer AM, Martin JB, Lovett WL, Morris JN Jr, Wangensteen SL: Production of a myocardial depressant factor in cardiogenic shock. Am Heart J 1971;82:78–85.

    External Resources

  23. Parrillo JE, Burch C, Shelhamer JH, Parker MM, Natanson C, Schuette W: A circulating myocardial depressant substance in humans with septic shock. Septic shock patients with a reduced ejection fraction have a circulating factor that depresses in vitro myocardial cell performance. J Clin Invest 1985;76:1539–1553.
  24. Kumar A, Thota V, Dee L, Olson J, Uretz E, Parrillo JE: Tumor necrosis factor alpha and interleukin 1 beta are responsible for in vitro myocardial cell depression induced by human septic shock serum. J Exp Med 1996;183:949–958.
  25. Kumar A, Brar R, Wang P, Dee L, Skorupa G, Khadour F, Schulz R, Parrillo JE: Role of nitric oxide and cGMP in human septic serum-induced depression of cardiac myocyte contractility. Am J Physiol 1999;276:R265–R276.

    External Resources

  26. Bellomo R, Tipping P, Boyce N: Continuous veno-venous hemofiltration with dialysis removes cytokines from the circulation of septic patients. Crit Care Med 1993;21:522–526.
  27. Grootendorst AF, van Bommel EFG, van der Hoven B, van Leengoed LA, van Osta AL: High volume hemofiltration improves right ventricular function in endotoxin-induced shock in the pig. Intensive Care Med 1992;18:235–240.
  28. Grootendorst AF, van Bommel EFG, van der Hoven B: High-volume hemofiltration improves hemodynamics of endotoxin-induced shock in the pig. J Crit Care 1992;7:67–75.

    External Resources

  29. Bellomo R, McGrath B, Boyce N: Effect of continuous venovenous hemofiltration with dialysis on hormone and catecholamine clearance in critically ill patients with acute renal failure. Crit Care Med 1994;22:833–837.

    External Resources

  30. Bellomo R, Ronco C: Continuous versus intermittent renal replacement therapy in the intensive care unit. Kidney Int Suppl 1998;66:S125–S128.

    External Resources

  31. Coraim FI, Wolner E: Continuous hemofiltration for the failing heart. New Horiz 1995;3:725–731.

    External Resources

  32. Baudouin SV, Wiggins J, Keogh BF, Morgan CJ, Evans TW: Continuous veno-venous haemofiltration following cardio-pulmonary bypass. Indications and outcome in 35 patients. Intensive Care Med 1993;19:290–293.
  33. Lamer C, Valleaux T, Plaisance P, Kucharski K, Payen D, Menasche P, Piwnica A: Continuous arteriovenous hemodialysis for acute renal failure after cardiac operations. J Thorac Cardiovasc Surg 1990;99:175–176.
  34. Bent P, Tan HK, Bellomo R, Buckmaster J, Doolan L, Hart G, Silvester W, Gutteridge G, Matalanis G, Raman J, Rosalion A, Buxton BF: Early and intensive continuous hemofiltration for severe renal failure after cardiac surgery. Ann Thorac Surg 2001;71:832–837.
  35. Levy B, Clavey M, Burtin P, Dopff CC, Hubert T, Villemot JP: Continuous venovenous hemofiltration after cardiac surgery. A retrospective study in 16 patients with multiple organ failure (in French). Ann Fr Anesth Reanim 1992;11:436–441.
  36. Tsang GMK, Khan I, Dar M, Clayton D, Waller D, Patel RL: Hemofiltration in a cardiac intensive care unit: Time for a rational approach. ASAIO J 1996;42:M710–M713.

    External Resources

  37. Liano F, Gallego A, Pascual J, Garcia-Martin F, Teruel JL, Marcen R, Orofino L, Orte L, Rivera M, Gallego N, et al: Prognosis of acute tubular necrosis: An extended prospectively contrasted study. Nephron 1993;63:21–31.

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