Is Zero-Balance Ultrafiltration an Effective Clinical Methodfor SIRS Prevention During Extracorporeal Circulation inAdults Heart Diseases Correction?

Abstract

Background: Ultrafiltration, which is currently considered as a standard method to remove the excess water administered during cardiopulmonary bypass (CPB), aims to minimize the adverse effects of hemodilution, such as tissue edema and blood transfusion. Three ultrafiltration techniques can be used before, during and after CPB procedure, including conventional ultrafiltration (CUF), zero-balance ultrafiltration (Z-BUF), and modified ultrafiltration (MUF) at the end of CPB.

The aim of study: The present research attempts to revise the efficiency of Z-BUF ultrafiltration method, laboratory results, and clinical impacts.

Material and methods: 94 adults (54 men and 40 women) with acquired heart diseases undergoing a single cardiac surgical procedure in condition of cardiopulmonary bypass (clamp aortic 89, 9± 38, 8 min. and pump 135,14 ± 45,17 min.) were divided into 3 groups. 1st group (no ultrafiltration) - 34 patients with classic cardiac surgery, 2nd with the use of zero-balance ultrafiltration (ZBUF) group - 37 patients with classic cardiac surgery, and 3rd group ZBUF with mini invasive cardiac surgery - 23 patients. ZBUF was performed by removing in the ratio of 3 l/m2  ultra filtrate using a hemoconcentrator with priming volume 133 ml. For myocardial protection,
“Bretschneider” solution 1500 ml for the first doze and 1000 ml for the second doze in case of necessity was used, or blood cardioplegia with St. Thomas II (15 mL/ kg) was also performed. Patient blood samples were taken before CPB (T1), immediately following CPB (T2), and 12 hours following the procedure (T3). There were no significant differences in diagnosis, age, sex, clinical status (Euroscore 1st-1,313, 2nd-1,891, 1,214 in a 3rd).

Results: Laboratory data demonstrate the presence of SIRS in all groups (high levels of leucocytes or reticulocytes, the presence of C reactive protein positive in 10, 5% cases of 1st gr., 10, 2% cases of 2nd gr. and 10,9% in 3rd gr. ). The length of mechanical ventilation was statistically lower in 3rd ZBUF group, and in 1st group than in 2nd ZBUF group: 7,21 ± 2,1 hour - 3rd gr., 9,40 ± 2,7 hour -1st, and 19,82 ±3,8 hour -2nd. The length of stay in ICU was statistically higher in 2nd ZBUF group ( 3,62 ± 1,5 days ) versus ( 2,62 ± 1,1 days ) control 1st group P = 0,03, but approximately equal with 3rd gr. ( 3,04±0,76 days ).

Conclusions: This study demonstrated that ZBUF ultrafiltration is an efficient method that can be used during CPB in the adults and helps to remove significant amounts of body water that seriously affects the clinical results. The use of ultrafiltration in our study, unfortunately, could not prevent organ dysfunction during the postoperative period and, however we think that it should have been used for volemic control in patients who underwent extracorporeal circulation. These results suggest with certainly, that Z-BUF improves the pulmonary function even in case of severe lung injury and may be an effective tool in attenuating the CPB derived inflammatory process. We think that in cases of SIRS signs before intervention and all complicated cases it is necessary MUF application that will improve the clinical results.