Changes in muscle compartment pressure after cardiopulmonary bypass.
OBJECTIVE
Hemodilution and inflammation lead to edema and increased muscle compartment pressure after cardiac surgery. The aim of this study was to find whether muscle compartment pressure was affected by the addition of albumin and mannitol to the pump prime, heparin coating or leukocyte depletion. Additionally, we studied the relationship between intraocular pressure and lower leg muscle compartment pressure. Edema during and following cardiac surgery is due to hemodynamic, osmotic and inflammatory changes, according to Starling's Law. We attempted to influence the osmotic balance and reduce the inflammatory response in order to reduce the edema.


METHODS
Thirty-six patients who underwent cardiac surgery were randomly allocated into four groups. Group A received albumin and mannitol into the pump prime. Group B had an, heparin-coated perfusion system, Group C had a leukocyte-depletion arterial line filter and Group D was the control group, where intraocular pressure was also measured.


RESULTS
Lower leg muscle compartment pressure increased significantly during and after cardiac surgery in all groups, but this increase was significantly less in Group A than in the control group 24 h after surgery. No correlation was found between muscular compartment pressure and intraocular pressure. The intraocular pressure profile is different from the muscular compartment pressure and recovers much faster.


CONCLUSIONS
Lower leg muscle compartment pressure and intraocular pressure behave differently during and after cardiac surgery. Albumin and mannitol added to the pump prime decreases muscle compartment pressure after cardiac surgery.
Símonardóttir
Líney
L
Department of Cardiothoracic Surgery, Landspitalinn - University Hospital, 101 Reykjavík, Iceland. liney@landspitali.is
Torfason
Bjarni
B
Stefánsson
Einar
E
Magnússon
Jónas
J
D000368:Aged; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D004234:Diuretics, Osmotic / Q000008:administration & dosage; D004487:Edema / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006438:Hemodilution / Q000009:adverse effects; D006801:Humans; D007249:Inflammation / Q000209:etiology / Q000503:physiopathology; D007429:Intraocular Pressure; D047589:Leukocyte Reduction Procedures; D008297:Male; D008353:Mannitol / Q000008:administration & dosage; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000503:physiopathology*; D011312:Pressure; D012709:Serum Albumin / Q000008:administration & dosage
D004234:Diuretics, Osmotic; D012709:Serum Albumin; D008353:Mannitol