Analysis of water balance for perioperative management in coronary artery bypass grafting

For patients who undergo heart surgery, it is well known that good perioperative body fluid management is important because it can affect the postoperative course, particularly the development of complications. The purpose of this study was to clarify the perioperative water balance in coronary artery bypass grafting (CABG) patients and to determine if certain prognostic predictive markers could be adapted for CABG perioperative care. Additionally, fluid balance was examined in CABG surgeries with and without a cardiopulmonary bypass (CPB). Eighteen patients who underwent CABG at Kawasaki Medical Hospital from March 2018 to February 2021 had their perioperative body water levels tracked. An InBody S10 body water analysis machine was used for measurements and the results were retrospectively analyzed. Correlations were found between the preoperative edema index (EI), which is the ratio of extracellular water to TBW, and various predictive markers including preoperative hemoglobin (R2: 0.4422, p = 0.0026), albumin (R2: 0.436, p = 0.00286), eGRF (R2: 0.305, p = 0.0173), and body mass index (BMI) (R2: 0.0103, p = 0.078). There was also a correlation between the maximum postoperative value of EI and the length of intensive care unit stay (R2: 0.3562, p = 0.01466). A sub-analysis was performed of CABG surgeries performed with and without a CPB. Non-CPB surgeries had a larger change in TBW, while CPB surgeries experienced a significantly larger change in EI. The EI can be a predictor of prognosis in CABG surgeries, and fluctuations in the EI were found to vary significantly depending on whether CPB was used or not.

Ochiai Y, et al