GKD Anest Yoð Bak Dern Derg. 2019; 25(4): 242-246 | DOI: 10.5222/GKDAD.2019.07269

The Effects Of Albumin Level And Management of Fluid Replacement on Postoperative Outcome in Cardiac Surgery

Nurþen Tanrýkulu¹, Babürhan Özbek², Ergun Demirsoy^1
1Kolan International Hospital, Department of Anesthesiology, Istanbul / Turkey
²Van Training and Research Hospital, Department of Cardiovascular Surgery, Van / Turkey

INTRODUCTION: Crystalloid sollutions are recommended as first choice for fluid replacement after cardiac surgery. Albumin and synthetic colloids are used in special condition. In this study, the effects of preoperative albumin level on postoperative period and the effects of albumin were investigated.
METHODS: Patients who underwent cardaic surgery between 01.01.2014 and 31.12.2018 were evaluated retrospectively. Patients were divided into two groups according to preoperative albumin levels. Patients with preoperative albumin level < 4 g / dl are in Group 1 and ≥ 4 g / dl in Group 2. Effects of preoperative albumin levels on early postoperative morbidity and mortality and its relationship with fluid replacement were evaluated.
RESULTS: Hypoalbuminemia persisted in postoperative period in patients with low preoperative albumin levels. During follow-up, 13 patients developed minor complications, of which 12 were in Group 1, and ten had albumin replacement. There were 10 mortality, (9 in Group 1, 1 in Group 2); although 7 of them underwent albumin replacement. It was seen that preoperative albumin value under 4 g / dl increased the risk of postoperative complications 14 times and the application of albumin replacement in these patients did not provide the expected contribution to the outcome.
DISCUSSION AND CONCLUSION: Low preoperative albumin value is associated with increased morbidity and mortality in the postoperative period, however, albumin replacement does not contribute positively to the outcome. In accordance with the recommendations of current guidelines, it would be appropriate to consider crystalloid solution as the first choice in cases where blood replacement is not required after cardiac surgery.

Keywords: Albumin, cardiac surgery, colloid, crystalloid, oncotic pressure

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Kalp Cerrahisinde Albümin Deðerinin ve Sývý Replasman Yönetiminin Postoperatif Döneme Etkisi

Nurþen Tanrýkulu¹, Babürhan Özbek², Ergun Demirsoy^1
1Kolan International Hospital, Anestezi Servisi, Ýstanbul / Türkiye
²Van Eðitim ve Araþtýrma Hastanesi, Kalp Damar Cerrahisi Servisi, Van / Türkiye

GÝRÝÞ ve AMAÇ: Kalp cerrahisi sonrasý sývý replasmanýnda ilk tercih olarak kristalloidler önerilmekle birlikte, bazý özel durumlarda albümin ve sentetik kolloidler de kullanýlabilmektedir. Bu çalýþmada preoperatif albümin deðerinin postoperatif döneme etkisi ve bu hastalarda albümin kullanýmýnýn sonuca etkileri araþtýrýldý.
YÖNTEM ve GEREÇLER: Servisimizde 01.01.2014-31.12.2018 tarihleri arasýnda açýk kalp cerrahisi uygulanan hastalar retrospektif olarak incelendi. Hastalar preoperatif albümin deðerlerine göre 2 gruba ayrýldý. Preoperatif albümin deðeri 4 gr/dl olan hastalar Grup 1’i, albümin deðeri 4 gr/dl üzerinde olan hastalar Grup 2’yi oluþturdu. Hastalarda preoperatif albümin deðerinin postoperatif erken dönem morbidite ve mortaliteye etkileri ve kullanýlan sývý replasmaný ile iliþkisi deðerlendirildi.
BULGULAR: Preoperatif albümin deðeri düþük olan hastalarda postoperatif dönemde de hipoalbüminemi devam etti. Takiplerde 13 hastada minör komplikasyon geliþirken bunun 12’si Grup 1’de olup, on hastaya albümin replasmaný uygulanmýþtý. Postoperatif dönemde 9’u Grup 1’de olmak üzere 10 mortali geliþti. Kaybedilen hastalarýn 7’sine postoperatif dönemde albümin replasmaný yapýlmasýna raðmen hastalar kaybedilmiþti. Preoperatif albümin deðerinin 4 g/dl altýnda olmasýnýn postoperatif komplikasyon riskini 14 kat arttýrdýðý ve bu hastalarda albümin replasmaný uygulanmasýnýn sonuca beklenen katkýyý saðlamadýðý görüldü.
TARTIÞMA ve SONUÇ: Preoperatif albümin deðerinün düþüklüðü postoperatif dönemde artmýþ morbidite ve mortalite ile iliþkili olmakla birlikte, albümin replasmaný sonuca olumlu katký saðlamamaktadýr. Güncel kýlavuzlarýn önerisi doðrultusunda kalp cerrahisi sonrasý sývý replasmanýnda kan replasmaný gerekmeyen durumlarda, kristalloid solüsyonunun ilk tercih olarak düþünülmesi doðru olacaktýr.

Anahtar Kelimeler: Albümin, kalp cerrahisi, kolloid, kristalloid, onkotik basýnç

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