Alfred Hospital, Monash University, Melbourne, Victoria, Australia; Vanderbilt University Medical Center, Nashville, TN.
Alfred Hospital, Monash University, Melbourne, Victoria, Australia.
J Cardiothorac Vasc Anesth. 2021 May;35(5):1321-1331. doi: 10.1053/j.jvca.2020.07.085. Epub 2020 Aug 7.
With the exception of 0.9% saline, little is known about factors that may contribute to increased serum chloride concentration (S) in patients undergoing cardiac surgery. For the present study, the authors sought to characterize the association between administered chloride load from intravenous fluid and other perioperative variables, with peak perioperative S.
Secondary analysis of data from a previously published controlled clinical trial in which patients were assigned to a chloride-rich or chloride-limited perioperative fluid strategy (NCT02020538).
Academic medical center.
The study comprised 1,056 adult patients with normal preoperative S undergoing cardiac surgery.
None MEASUREMENTS AND MAIN RESULTS: Peak perioperative S and hyperchloremia, defined as peak S >110 mmol/L, were selected as co-primary endpoints. Regression modeling identified factors independently associated with these endpoints. Mean (standard deviation) peak perioperative S was 114 (5) mmol/L, and hyperchloremia occurred in 824 (78.0%) of the cohort. In addition to administered volume of 0.9% saline, multivariate linear and logistic regression modeling consistently associated preoperative S (regression coefficient 0.5; 95% confidence interval [CI] 0.4-0.6 mmol/L; odds ratio 1.60; 95% CI 1.41-1.82 per 1 mmol/L increase) and cardiopulmonary bypass duration (regression coefficient 0.1; 95% CI 0.1-0.2 mmol/L; odds ratio 1.12; 95% CI 1.06-1.19 per 10 minutes) with both co-primary outcomes. Multivariate modeling only explained approximately 50% of variability in peak S.
The present study's data identified an association for both 0.9% saline administration and other nonfluid variables with peak perioperative S and hyperchloremia. Stand-alone strategies to limit administration of chloride-rich intravenous fluid may have limited ability to prevent hyperchloremia in this setting.
除了 0.9%生理盐水外，对于可能导致心脏手术患者血清氯浓度（S）升高的因素知之甚少。在本研究中，作者试图描述静脉输液中的氯负荷与其他围手术期变量与围手术期 S 峰值之间的关系。
对先前发表的一项对照临床试验数据的二次分析，其中患者被分配到富含氯或氯限制的围手术期液体策略（NCT02020538）。
学术医疗中心。
本研究包括 1056 名术前 S 正常的成年心脏手术患者。
无
选择围手术期 S 峰值和高氯血症（定义为 S 峰值>110mmol/L）作为共同主要终点。回归模型确定了与这些终点独立相关的因素。平均（标准差）围手术期 S 峰值为 114（5）mmol/L，队列中有 824 例（78.0%）发生高氯血症。除了 0.9%生理盐水的使用量外，多变量线性和逻辑回归模型一致地将术前 S（回归系数 0.5；95%置信区间[CI] 0.4-0.6mmol/L；比值比 1.60；95%CI 1.41-1.82 每增加 1mmol/L）和体外循环持续时间（回归系数 0.1；95%CI 0.1-0.2mmol/L；比值比 1.12；95%CI 1.06-1.19 每增加 10 分钟）与两个共同主要结局相关。多变量模型仅能解释 S 峰值变异性的约 50%。
本研究的数据确定了 0.9%生理盐水的使用和其他非液体变量与围手术期 S 峰值和高氯血症的关系。单独限制富含氯的静脉输液的策略在这种情况下可能无法防止高氯血症。
