Prolonged cardiovascular pharmacological support and fluid management after cardiac surgery

Loay Kontar; William Beaubien-Souligny; Etienne J Couture; Matthias Jacquet-Lagrèze; Yoan Lamarche; Sylvie Levesque; Denis Babin; André Y Denault

doi:10.1371/journal.pone.0285526

Prolonged cardiovascular pharmacological support and fluid management after cardiac surgery

PLoS One. 2023 May 11;18(5):e0285526. doi: 10.1371/journal.pone.0285526. eCollection 2023.

Authors

Loay Kontar^{1

2

3}, William Beaubien-Souligny^{1

4}, Etienne J Couture⁵, Matthias Jacquet-Lagrèze¹, Yoan Lamarche⁶, Sylvie Levesque⁷, Denis Babin¹, André Y Denault^{1

2}

Affiliations

¹ Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
² Division of Intensive Care Unit, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.
³ Medical Intensive Care Unit, Centre Hospitalier Universitaire d'Amiens, Amiens, France.
⁴ Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.
⁵ Department of Anesthesiology and Intensive Care Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec, Quebec, Canada.
⁶ Department of Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
⁷ Montreal Health Innovations Coordinating Centre, Montreal Heart Institute, Montreal, Quebec, Canada.

Abstract

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.

Copyright: © 2023 Kontar et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cardiac Surgical Procedures* / adverse effects
Cardiopulmonary Bypass / adverse effects
Cardiovascular Agents*
Humans
Prospective Studies
Stroke Volume
Ventricular Function, Left

Substances

Cardiovascular Agents

Grants and funding

This work was supported by the Montreal Heart Institute Foundation and the Richard I. Kaufman Endowment Fund in Anesthesia and Critical Care, Montreal. All the funding sources had no involvement in this study. There was no additional external funding received for this study. This confirms that the funders provided support in the form of salaries, equipment, drugs and/or supplies for the author (AYD), but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific role of this author is articulated in the ‘author contributions’ section.