Vol.3 - No.2

Relevance of colloid oncotic pressure regulation during neonatal and infant cardiopulmonary bypass: a prospective randomized study

By : baghaei

Keywords : Infant and neonatal cardiopulmonary bypass,Colloid oncotic pressure, Albumin concentration, Fluid balance

In neonatal and infant cardiac surgery with cardiopulmonary
bypass (CPB), hemodilution with reduction
of plasma albumin concentration and low colloid oncotic
pressure (COP) are the main factors associated with tissue
edema and postoperative weight gain. The aim of our study
was to evaluate the influence of two different COP regulatory
strategies on post-bypass body weight gain, fluid balance,
and clinical outcomes.

Methods

Seventy elective patients with body weight < 10
kg underwent first-time cardiac surgery with CPB and were
randomized into two groups. The standard COP group received
0.5 g kg-1 of human albumin in the priming and,
during CPB, albumin was added to maintain the COP > 15
mmHg. In the high COP group, albumin concentration in
the priming was 5% and, during CPB, the COP was maintained
above 18 mmHg. All patients were monitored before,
during and until 24 h postoperatively. Data were collected
on body weight gain, COP, albumin concentration, fluids
transfusion, blood loss, urine production and laboratory results.

Results

Patients' demographics and operative data were
comparable. Although the high COP group had perioperatively
significantly higher COP and albumin concentration than the standard COP group, no significant difference was
found in the body weight gain. There were also no significant
differences between the groups with respect to fluid
balance, urine output and blood loss. However, the high
COP group had significantly shorter postoperative duration
of mechanical ventilation (10 h vs 14 h, p = 0.02) and lower
plasma lactate concentration post operation (1.1 mmol l-1
vs 1.4 mmol l-1, p = 0.046).

Conclusion

The COP regulatory strategy for neonatal and
infant CPB, based upon the 5% concentration of albumin in
the priming and a COP target of 18 mmHg during bypass,
better preserves the plasma albumin concentration within
the physiological range and stabilizes the colloid pressure
than the standard strategy (0.5 g kg-1 albumin in the priming
and bypass COP target at 15 mmHg). Nevertheless,
only the lower postoperative plasma lactate concentration
and the shorter duration of mechanical ventilation in the
high COP group indicated the potential clinical benefit of
this new strategy

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