Department of Pediatric Intensive Care, 28928Sir Ganga Ram Hospital, New Delhi, Delhi, India.
Department of Pediatric Cardiac Sciences, 28928Sir Ganga Ram Hospital, New Delhi, Delhi, India.
World J Pediatr Congenit Heart Surg. 2021 Jan;12(1):61-69. doi: 10.1177/2150135120959088. Epub 2020 Oct 20.
There is a paucity of literature regarding the association of high oncotic priming solutions for pediatric cardiopulmonary bypass (CPB) and outcomes, and no consensus exists regarding the composition of optimal CPB priming solution. This study aimed to examine the impact of high oncotic pressure priming by the addition of 20% human albumin on outcomes.
Double-blinded, randomized controlled study was done in the pediatric cardiac intensive care unit of a tertiary care hospital. Consecutive children with congenital heart diseases admitted for open-heart surgery were randomized into two groups, where the study group received an additional 20% albumin to conventional blood prime before CPB initiation.
We enrolled 39 children in the high oncotic prime (added albumin) group and 37 children in the conventional prime group. In the first 24-hour postoperative period, children in the albumin group had significantly lower occurrence of hypotension (28.2% vs 54%, = .02), requirement of fluid boluses (25.6% vs 54%, = .006), and lactate clearance time (6 vs 9 hours, < .001). Albumin group also had significantly higher platelet count (×10/µL) at 24 hours (112 vs 91, = .02). There was no significant difference in intra-CPB hemodynamic parameters and incidence of acute kidney injury. In subgroup analysis based on risk category, significantly decreased intensive care unit stay (4 vs 5 days, = .04) and hospital stay (5 vs 7 days, = .002) were found in the albumin group in low-risk category.
High oncotic pressure CPB prime using albumin addition might be beneficial over conventional blood prime, and our study does provide a rationale for further studies.
关于小儿体外循环（CPB）中高渗透压预充液与结果的关系，文献报道较少，关于最佳 CPB 预充液组成也没有共识。本研究旨在探讨添加 20%人血白蛋白提高渗透压预充对结果的影响。
在一家三级医院的儿科心脏重症监护病房进行了一项双盲、随机对照研究。连续纳入因先天性心脏病接受心脏直视手术的儿童，并将其随机分为两组，研究组在 CPB 启动前的常规血液预充液中添加额外的 20%白蛋白。
我们共纳入 39 例接受高渗透压预充（添加白蛋白）的患儿和 37 例接受常规预充的患儿。在术后 24 小时内，白蛋白组患儿低血压的发生率（28.2% vs 54%， =.02）、液体冲击的需求（25.6% vs 54%， =.006）和乳酸清除时间（6 小时 vs 9 小时， <.001）显著较低。白蛋白组在 24 小时时血小板计数（×10/µL）也显著较高（112 vs 91， =.02）。CPB 期间的血液动力学参数和急性肾损伤的发生率无显著差异。根据风险类别进行亚组分析，在低危组中，白蛋白组的重症监护病房停留时间（4 天 vs 5 天， =.04）和住院时间（5 天 vs 7 天， =.002）显著缩短。
与常规血液预充相比，使用白蛋白提高渗透压预充可能有益，本研究确实为进一步研究提供了依据。
