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Archived Comments for: Fluid overload and changes in serum creatinine after cardiac surgery: predictors of mortality and longer intensive care stay. A prospective cohort study

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  1. Fluid overload after cardiac surgery: too much or the right therapy?

    Andrea Rossi Zadra, Terapia intensiva cardiovascolare, ASO S Croce e Carle, Cuneo - Italy

    26 September 2012

    The work of Stein and colleagues addresses a key issue in cardiac anesthesia and critical care: optimal fluid management may deeply impact on prognosis. The conclusions may suggest cautious intake of fluids to prevent complications, including kidney failure. Despite extensive literature warns against fluid overload, we suggest that correct fluid management should be titrated to reach adequate volemia. After cardiac surgery the question about fluid status may change compared to preoperative conditions: what is now the correct volemia for the patient? Type of surgery, e.g. aortic valve replacement, and inflammation after extracorporeal circulation deeply impact on volume distribution and cardiac preload. Inadequate volemia is associated to poor perfusion and low cardiac output. Thus, the answer should be searched in a pool of data available at bedside. Central pressures, pulmonary artery catheter calculations, stroke volume variation, echocardiography assessment of cardiac filling should be measured to assess the right amount of fluids needed. Ejection fraction is a key parameter to titrate the right cardiac preload before and after surgery. In this paper it was measured preoperatively for 312 out of 502 patients. Only 66 patients experienced more than 2 days of ICU, and a fluid overload could be an epiphenomenon of impaired conditions for other reasons.The fluid status in this population can not be identified because of lack of data about actual patients¿ volemia. Fluid intake after cardiac surgery should be guided by bedside measures, and both overload and restriction may be associated to negative outcome.

    Competing interests

    The Author declares no conflicts of interest

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