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Prolonged cardiovascular pharmacological support and fluid management after cardiac surgery
OBJECTIVE: To identify potentially modifiable risk factors related to prolonged cardiovascular pharmacological support after weaning from cardiopulmonary bypass (CPB). METHODS: This is a secondary analysis of two prospective cohort study in a specialized cardiac surgery institution in adult patients...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10174538/ https://www.ncbi.nlm.nih.gov/pubmed/37167244 http://dx.doi.org/10.1371/journal.pone.0285526 |
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author | Kontar, Loay Beaubien-Souligny, William Couture, Etienne J. Jacquet-Lagrèze, Matthias Lamarche, Yoan Levesque, Sylvie Babin, Denis Denault, André Y. |
author_facet | Kontar, Loay Beaubien-Souligny, William Couture, Etienne J. Jacquet-Lagrèze, Matthias Lamarche, Yoan Levesque, Sylvie Babin, Denis Denault, André Y. |
author_sort | Kontar, Loay |
collection | PubMed |
description | OBJECTIVE: To identify potentially modifiable risk factors related to prolonged cardiovascular pharmacological support after weaning from cardiopulmonary bypass (CPB). METHODS: This is a secondary analysis of two prospective cohort study in a specialized cardiac surgery institution in adult patients undergoing cardiac surgery with the use of CPB between August 2016 and July 2017. Prolonged cardiovascular pharmacological support was defined by the need for at least one vasopressor or one inotropic agent 24 hours after separation from CPB. Risk factors were identified among baseline characteristics and peri-operative events through multivariable logistic regression. RESULTS: A total of 247 patients were included and 98 (39.7%) developed prolonged pharmacological support. In multivariable analysis, left ventricular ejection fraction ≤ 30% (OR 9.52, 95% confidence interval (CI) 1.14; 79.25), elevated systolic pulmonary artery pressure (sPAP) > 30 and ≤ 55 mmHg (moderate) (OR 2.52, CI 1.15; 5.52) and sPAP > 55 mmHg (severe) (OR 8.12, CI 2.54; 26.03), as well as cumulative fluid balance in the first 24 hours after surgery (OR 1.76, CI 1.32; 2.33) were independently associated with the development of prolonged pharmacological support. CONCLUSIONS: Prolonged cardiovascular pharmacological support is frequent after cardiac surgery on CPB. Severe LV systolic dysfunction, preoperative pulmonary hypertension and postoperative fluid overload are risk factors. Further studies are required to explore if those risk factors could be modified or not. |
format | Online Article Text |
id | pubmed-10174538 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-101745382023-05-12 Prolonged cardiovascular pharmacological support and fluid management after cardiac surgery Kontar, Loay Beaubien-Souligny, William Couture, Etienne J. Jacquet-Lagrèze, Matthias Lamarche, Yoan Levesque, Sylvie Babin, Denis Denault, André Y. PLoS One Research Article OBJECTIVE: To identify potentially modifiable risk factors related to prolonged cardiovascular pharmacological support after weaning from cardiopulmonary bypass (CPB). METHODS: This is a secondary analysis of two prospective cohort study in a specialized cardiac surgery institution in adult patients undergoing cardiac surgery with the use of CPB between August 2016 and July 2017. Prolonged cardiovascular pharmacological support was defined by the need for at least one vasopressor or one inotropic agent 24 hours after separation from CPB. Risk factors were identified among baseline characteristics and peri-operative events through multivariable logistic regression. RESULTS: A total of 247 patients were included and 98 (39.7%) developed prolonged pharmacological support. In multivariable analysis, left ventricular ejection fraction ≤ 30% (OR 9.52, 95% confidence interval (CI) 1.14; 79.25), elevated systolic pulmonary artery pressure (sPAP) > 30 and ≤ 55 mmHg (moderate) (OR 2.52, CI 1.15; 5.52) and sPAP > 55 mmHg (severe) (OR 8.12, CI 2.54; 26.03), as well as cumulative fluid balance in the first 24 hours after surgery (OR 1.76, CI 1.32; 2.33) were independently associated with the development of prolonged pharmacological support. CONCLUSIONS: Prolonged cardiovascular pharmacological support is frequent after cardiac surgery on CPB. Severe LV systolic dysfunction, preoperative pulmonary hypertension and postoperative fluid overload are risk factors. Further studies are required to explore if those risk factors could be modified or not. Public Library of Science 2023-05-11 /pmc/articles/PMC10174538/ /pubmed/37167244 http://dx.doi.org/10.1371/journal.pone.0285526 Text en © 2023 Kontar et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Kontar, Loay Beaubien-Souligny, William Couture, Etienne J. Jacquet-Lagrèze, Matthias Lamarche, Yoan Levesque, Sylvie Babin, Denis Denault, André Y. Prolonged cardiovascular pharmacological support and fluid management after cardiac surgery |
title | Prolonged cardiovascular pharmacological support and fluid management after cardiac surgery |
title_full | Prolonged cardiovascular pharmacological support and fluid management after cardiac surgery |
title_fullStr | Prolonged cardiovascular pharmacological support and fluid management after cardiac surgery |
title_full_unstemmed | Prolonged cardiovascular pharmacological support and fluid management after cardiac surgery |
title_short | Prolonged cardiovascular pharmacological support and fluid management after cardiac surgery |
title_sort | prolonged cardiovascular pharmacological support and fluid management after cardiac surgery |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10174538/ https://www.ncbi.nlm.nih.gov/pubmed/37167244 http://dx.doi.org/10.1371/journal.pone.0285526 |
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