Conservative fluid resuscitation protocol does not reduce the incidence of reoperation for bleeding after emergency CABG
Reoperation for bleeding (ROB) after emergency coronary artery bypass grafting (eCABG) has been identified as an independent risk factor for mortality. Consecutively, the influence of fluid intake, fluid output, fluid balance, blood loss, and inotropic demand on ROB were analyzed. This retrospective...
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| Vydáno v: | Scientific reports Ročník 14; číslo 1; s. 21037 - 10 |
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| Jazyk: | angličtina |
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Nature Publishing Group UK
09.09.2024
Nature Publishing Group Nature Portfolio |
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| ISSN: | 2045-2322, 2045-2322 |
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| Abstract | Reoperation for bleeding (ROB) after emergency coronary artery bypass grafting (eCABG) has been identified as an independent risk factor for mortality. Consecutively, the influence of fluid intake, fluid output, fluid balance, blood loss, and inotropic demand on ROB were analyzed. This retrospective single-center study included 265 patients undergoing eCABG between 2011 and 2020. From 2018, postoperative hemodynamic management was performed with lower volume administration and higher vasoactive support. The primary outcome measure was the incidence of ROB within 48 h according to altered fluid resuscitation strategy. Consecutively, the influence of fluid intake, fluid output, fluid balance, blood loss, and inotropic demand on ROB were analyzed. Incidence of ROB was independent from the volume resuscitation protocol (
P
= .3). The ROB group had a higher perioperative risk, which was observed in EuroSCORE II. Fluid intake (
P
= .021), fluid balance (
P
= .001), and norepinephrine administration (
P
= .004) were associated with ROB. Fluid output and blood loss were not associated with ROB (
P
= .22). Post-test probability was low among all variables. Although fluid management might have an impact on specific postoperative complications, different fluid resuscitation protocols did not alter the incidence of ROB after emergency CABG.
Trial registration:
www.clinicaltrials.gov
registration number NCT04533698; date of registration: August 31, 2020 (retrospectively registered due to nature of the study); URL:
https://classic.clinicaltrials.gov/ct2/show/NCT04533698 |
|---|---|
| AbstractList | Reoperation for bleeding (ROB) after emergency coronary artery bypass grafting (eCABG) has been identified as an independent risk factor for mortality. Consecutively, the influence of fluid intake, fluid output, fluid balance, blood loss, and inotropic demand on ROB were analyzed. This retrospective single-center study included 265 patients undergoing eCABG between 2011 and 2020. From 2018, postoperative hemodynamic management was performed with lower volume administration and higher vasoactive support. The primary outcome measure was the incidence of ROB within 48 h according to altered fluid resuscitation strategy. Consecutively, the influence of fluid intake, fluid output, fluid balance, blood loss, and inotropic demand on ROB were analyzed. Incidence of ROB was independent from the volume resuscitation protocol (P = .3). The ROB group had a higher perioperative risk, which was observed in EuroSCORE II. Fluid intake (P = .021), fluid balance (P = .001), and norepinephrine administration (P = .004) were associated with ROB. Fluid output and blood loss were not associated with ROB (P = .22). Post-test probability was low among all variables. Although fluid management might have an impact on specific postoperative complications, different fluid resuscitation protocols did not alter the incidence of ROB after emergency CABG.Trial registration: www.clinicaltrials.gov registration number NCT04533698; date of registration: August 31, 2020 (retrospectively registered due to nature of the study); URL: https://classic.clinicaltrials.gov/ct2/show/NCT04533698 Reoperation for bleeding (ROB) after emergency coronary artery bypass grafting (eCABG) has been identified as an independent risk factor for mortality. Consecutively, the influence of fluid intake, fluid output, fluid balance, blood loss, and inotropic demand on ROB were analyzed. This retrospective single-center study included 265 patients undergoing eCABG between 2011 and 2020. From 2018, postoperative hemodynamic management was performed with lower volume administration and higher vasoactive support. The primary outcome measure was the incidence of ROB within 48 h according to altered fluid resuscitation strategy. Consecutively, the influence of fluid intake, fluid output, fluid balance, blood loss, and inotropic demand on ROB were analyzed. Incidence of ROB was independent from the volume resuscitation protocol ( P = .3). The ROB group had a higher perioperative risk, which was observed in EuroSCORE II. Fluid intake ( P = .021), fluid balance ( P = .001), and norepinephrine administration ( P = .004) were associated with ROB. Fluid output and blood loss were not associated with ROB ( P = .22). Post-test probability was low among all variables. Although fluid management might have an impact on specific postoperative complications, different fluid resuscitation protocols did not alter the incidence of ROB after emergency CABG. Trial registration: www.clinicaltrials.gov registration number NCT04533698; date of registration: August 31, 2020 (retrospectively registered due to nature of the study); URL: https://classic.clinicaltrials.gov/ct2/show/NCT04533698 Reoperation for bleeding (ROB) after emergency coronary artery bypass grafting (eCABG) has been identified as an independent risk factor for mortality. Consecutively, the influence of fluid intake, fluid output, fluid balance, blood loss, and inotropic demand on ROB were analyzed. This retrospective single-center study included 265 patients undergoing eCABG between 2011 and 2020. From 2018, postoperative hemodynamic management was performed with lower volume administration and higher vasoactive support. The primary outcome measure was the incidence of ROB within 48 h according to altered fluid resuscitation strategy. Consecutively, the influence of fluid intake, fluid output, fluid balance, blood loss, and inotropic demand on ROB were analyzed. Incidence of ROB was independent from the volume resuscitation protocol (P = .3). The ROB group had a higher perioperative risk, which was observed in EuroSCORE II. Fluid intake (P = .021), fluid balance (P = .001), and norepinephrine administration (P = .004) were associated with ROB. Fluid output and blood loss were not associated with ROB (P = .22). Post-test probability was low among all variables. Although fluid management might have an impact on specific postoperative complications, different fluid resuscitation protocols did not alter the incidence of ROB after emergency CABG.Reoperation for bleeding (ROB) after emergency coronary artery bypass grafting (eCABG) has been identified as an independent risk factor for mortality. Consecutively, the influence of fluid intake, fluid output, fluid balance, blood loss, and inotropic demand on ROB were analyzed. This retrospective single-center study included 265 patients undergoing eCABG between 2011 and 2020. From 2018, postoperative hemodynamic management was performed with lower volume administration and higher vasoactive support. The primary outcome measure was the incidence of ROB within 48 h according to altered fluid resuscitation strategy. Consecutively, the influence of fluid intake, fluid output, fluid balance, blood loss, and inotropic demand on ROB were analyzed. Incidence of ROB was independent from the volume resuscitation protocol (P = .3). The ROB group had a higher perioperative risk, which was observed in EuroSCORE II. Fluid intake (P = .021), fluid balance (P = .001), and norepinephrine administration (P = .004) were associated with ROB. Fluid output and blood loss were not associated with ROB (P = .22). Post-test probability was low among all variables. Although fluid management might have an impact on specific postoperative complications, different fluid resuscitation protocols did not alter the incidence of ROB after emergency CABG.www.TRIAL REGISTRATIONwww.gov registration number NCT04533698; date of registration: August 31, 2020 (retrospectively registered due to nature of the study); URL: https://classic.CLINICALTRIALSgov registration number NCT04533698; date of registration: August 31, 2020 (retrospectively registered due to nature of the study); URL: https://classic.gov/ct2/show/NCT04533698.CLINICALTRIALSgov/ct2/show/NCT04533698. Reoperation for bleeding (ROB) after emergency coronary artery bypass grafting (eCABG) has been identified as an independent risk factor for mortality. Consecutively, the influence of fluid intake, fluid output, fluid balance, blood loss, and inotropic demand on ROB were analyzed. This retrospective single-center study included 265 patients undergoing eCABG between 2011 and 2020. From 2018, postoperative hemodynamic management was performed with lower volume administration and higher vasoactive support. The primary outcome measure was the incidence of ROB within 48 h according to altered fluid resuscitation strategy. Consecutively, the influence of fluid intake, fluid output, fluid balance, blood loss, and inotropic demand on ROB were analyzed. Incidence of ROB was independent from the volume resuscitation protocol (P = .3). The ROB group had a higher perioperative risk, which was observed in EuroSCORE II. Fluid intake (P = .021), fluid balance (P = .001), and norepinephrine administration (P = .004) were associated with ROB. Fluid output and blood loss were not associated with ROB (P = .22). Post-test probability was low among all variables. Although fluid management might have an impact on specific postoperative complications, different fluid resuscitation protocols did not alter the incidence of ROB after emergency CABG. www. gov registration number NCT04533698; date of registration: August 31, 2020 (retrospectively registered due to nature of the study); URL: https://classic. gov/ct2/show/NCT04533698. Reoperation for bleeding (ROB) after emergency coronary artery bypass grafting (eCABG) has been identified as an independent risk factor for mortality. Consecutively, the influence of fluid intake, fluid output, fluid balance, blood loss, and inotropic demand on ROB were analyzed. This retrospective single-center study included 265 patients undergoing eCABG between 2011 and 2020. From 2018, postoperative hemodynamic management was performed with lower volume administration and higher vasoactive support. The primary outcome measure was the incidence of ROB within 48 h according to altered fluid resuscitation strategy. Consecutively, the influence of fluid intake, fluid output, fluid balance, blood loss, and inotropic demand on ROB were analyzed. Incidence of ROB was independent from the volume resuscitation protocol (P = .3). The ROB group had a higher perioperative risk, which was observed in EuroSCORE II. Fluid intake (P = .021), fluid balance (P = .001), and norepinephrine administration (P = .004) were associated with ROB. Fluid output and blood loss were not associated with ROB (P = .22). Post-test probability was low among all variables. Although fluid management might have an impact on specific postoperative complications, different fluid resuscitation protocols did not alter the incidence of ROB after emergency CABG. Trial registration: www.clinicaltrials.gov registration number NCT04533698; date of registration: August 31, 2020 (retrospectively registered due to nature of the study); URL: https://classic.clinicaltrials.gov/ct2/show/NCT04533698 Abstract Reoperation for bleeding (ROB) after emergency coronary artery bypass grafting (eCABG) has been identified as an independent risk factor for mortality. Consecutively, the influence of fluid intake, fluid output, fluid balance, blood loss, and inotropic demand on ROB were analyzed. This retrospective single-center study included 265 patients undergoing eCABG between 2011 and 2020. From 2018, postoperative hemodynamic management was performed with lower volume administration and higher vasoactive support. The primary outcome measure was the incidence of ROB within 48 h according to altered fluid resuscitation strategy. Consecutively, the influence of fluid intake, fluid output, fluid balance, blood loss, and inotropic demand on ROB were analyzed. Incidence of ROB was independent from the volume resuscitation protocol (P = .3). The ROB group had a higher perioperative risk, which was observed in EuroSCORE II. Fluid intake (P = .021), fluid balance (P = .001), and norepinephrine administration (P = .004) were associated with ROB. Fluid output and blood loss were not associated with ROB (P = .22). Post-test probability was low among all variables. Although fluid management might have an impact on specific postoperative complications, different fluid resuscitation protocols did not alter the incidence of ROB after emergency CABG. Trial registration: www.clinicaltrials.gov registration number NCT04533698; date of registration: August 31, 2020 (retrospectively registered due to nature of the study); URL: https://classic.clinicaltrials.gov/ct2/show/NCT04533698 |
| ArticleNumber | 21037 |
| Author | Gahl, Brigitta Reuthebuch, Oliver T. Eckstein, Friedrich S. Gebhard, Caroline E. Bruno, Jowita Varayath, Mascha Santer, David Miazza, Jules Hollinger, Alexa Siegemund, Martin |
| Author_xml | – sequence: 1 givenname: Jowita surname: Bruno fullname: Bruno, Jowita organization: Intensive Care Unit, University Hospital Basel – sequence: 2 givenname: Mascha surname: Varayath fullname: Varayath, Mascha organization: Clinic for Anaesthesiology, University Hospital Basel – sequence: 3 givenname: Brigitta surname: Gahl fullname: Gahl, Brigitta organization: Department of Cardiac Surgery, University Hospital Basel – sequence: 4 givenname: Jules surname: Miazza fullname: Miazza, Jules organization: Department of Cardiac Surgery, University Hospital Basel – sequence: 5 givenname: Caroline E. surname: Gebhard fullname: Gebhard, Caroline E. organization: Intensive Care Unit, University Hospital Basel, Medical Faculty of the University of Basel – sequence: 6 givenname: Oliver T. surname: Reuthebuch fullname: Reuthebuch, Oliver T. organization: Department of Cardiac Surgery, University Hospital Basel, Medical Faculty of the University of Basel – sequence: 7 givenname: Friedrich S. surname: Eckstein fullname: Eckstein, Friedrich S. organization: Department of Cardiac Surgery, University Hospital Basel, Medical Faculty of the University of Basel – sequence: 8 givenname: Martin surname: Siegemund fullname: Siegemund, Martin email: martin.siegemund@usb.ch organization: Intensive Care Unit, University Hospital Basel, Medical Faculty of the University of Basel – sequence: 9 givenname: Alexa surname: Hollinger fullname: Hollinger, Alexa organization: Intensive Care Unit, University Hospital Basel, Medical Faculty of the University of Basel – sequence: 10 givenname: David surname: Santer fullname: Santer, David organization: Department of Cardiac Surgery, University Hospital Basel, Medical Faculty of the University of Basel |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/39251616$$D View this record in MEDLINE/PubMed |
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| Snippet | Reoperation for bleeding (ROB) after emergency coronary artery bypass grafting (eCABG) has been identified as an independent risk factor for mortality.... Abstract Reoperation for bleeding (ROB) after emergency coronary artery bypass grafting (eCABG) has been identified as an independent risk factor for... |
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| SubjectTerms | 692/308 692/308/409 Aged Bleeding Blood Bypass Cardiac surgery Complications Coronary artery Coronary Artery Bypass - adverse effects Coronary Artery Bypass - methods Female Fluid intake Fluid Therapy - methods Heart surgery Humanities and Social Sciences Humans Incidence Male Middle Aged multidisciplinary Norepinephrine Postoperative Postoperative bleeding Postoperative Hemorrhage - epidemiology Postoperative Hemorrhage - etiology Postoperative Hemorrhage - therapy Registration Reoperation Resuscitation - adverse effects Resuscitation - methods Retrospective Studies Risk Factors Science Science (multidisciplinary) Vasoactive agents Volume resuscitation protocol |
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| Title | Conservative fluid resuscitation protocol does not reduce the incidence of reoperation for bleeding after emergency CABG |
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