[Perioperative management of uremia and fluid balance in patients with compromised renal function undergoing open heart surgery].
Five patients with renal dysfunction underwent coronary artery bypass grafting (CABG). Three patients were in cardiogenic shock with acute myocardial infarction for whom CABG was carried out on emergent basis. Immediate preoperatively these patients were in almost anuria which was derived from sustained renal dysfunction plus decreased renal perfusion due to low cardiac output. The other two patients were operated on electively, and hemodynamic instability and artificial perfusion (cardiopulmonary bypass) affected their chronic renal disease (polycystic kidney and nephrosclerosis, respectively) so unfavorably that intraoperative anuria took place. In all patients intraoperative control of fluid balance and prevention of azotemia were accomplished by intraoperative hemofiltration (HF), in which 10 litters of body fluid was filtered out through a hemofiliter incorporated into the cardiopulmonary bypass circuit, and replaced with saline solution. In emergent cases (three patients) complete anuria was sustained and continuous hemodialysis/hemofilitration (CHDF) was successively performed to control water balance and to prevent exacerbation of uremia. Although they all were in profound low cardiac output state necessitating intraaortic balloon counterpulsation (IABP) and infusion of considerable amount of catecholamines, there was no hemodynamic instability occurred throughout the period of CHDF. In four cases renal function recovered significantly along with the recover from their cardiogenic shock so that they could wean from the hemodialysis therapy. In the remaining case intermittent hemodialysis was necessary in chronic phase. There were no hospital death nor late mortality. From this experience we might conclude that the combined use of intraoperative HF and successive postoperative CHDF is an effective method for controlling fluid balance and preventing uremia in cardiac surgical patients with severe renal dysfunction along with considerable hemodynamic instability.
Tanaka
S
S
Department of Cardiovascular Surgery, Hokko Cardiovascular Hospital, Sapporo, Japan.
Watanabe
S
S
Hayashi
K
K
Ogawa
M
M
Yamanishi
H
H
Minami
M
M
Miyamoto
K
K
Shindo
N
N
D000368:Aged; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D005260:Female; D006439:Hemodynamics; D006440:Hemofiltration; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery; D011182:Postoperative Care; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000503:physiopathology / Q000628:therapy*; D012770:Shock, Cardiogenic / Q000601:surgery; D014511:Uremia / Q000517:prevention & control*; D014882:Water-Electrolyte Balance