Hemofiltration but not steroids results in earlier tracheal extubation following cardiopulmonary bypass: A prospective, randomized double-blind trial

William C. Oliver, Gregory A. Nuttall, Thomas A. Orszulak, William R. Bamlet, Martin D. Abel, Mark H. Ereth, Hartzell V Schaff

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Background: Activation of the inflammatory cascade is thought to account for some of the respiratory dysfunction and prolonged mechanical ventilation associated with cardiopulmonary bypass. The objective of this investigation was to identify whether perioperative steroids or hemofiltration during cardiopulmonary bypass, by their attenuation of inflammation, would reduce duration of mechanical ventilation after cardiac surgery. Methods: After Institutional Review Board approval and informed consent, 192 patients scheduled to undergo elective primary coronary artery bypass grafting or valvular replacement or repair were randomized in a double-blind prospective study into three groups. One group (Control) received saline at induction and at 6-h intervals for four doses. Another group (Hemofil) received saline and hemofiltration to obtain 27 ml/kg of hemofiltrate. The final group (Steroid) received 1 g methylprednisolone before anesthesia induction and then 4 mg of dexamethasone at 6-h intervals for four doses. All patients underwent normothermic cardiopulmonary bypass and received propofol for postoperative sedation. Separate two-sample comparisons were performed to compare each experimental group versus the control group using the Wilcoxon rank sum test for continuous variables and Fisher exact test for categorical variables. In all cases, two-tailed P values ≤ 0.05 were considered statistically significant. Results: The median time until the patient reached an intermittent mandatory ventilation of 4/min (258.5 versus 385.0 min, respectively; P = 0.02) and tracheal extubation (352.0 versus 518.0 min; P = 0.03) was significantly reduced for group Hemofil but no different for Steroid compared to Control. Conclusions: Hemofiltration and steroids are both previously reported to attenuate the inflammatory response but only hemofiltration reduced time to tracheal extubation for adults after cardiopulmonary bypass in this study.

Original languageEnglish (US)
Pages (from-to)327-339
Number of pages13
JournalAnesthesiology
Volume101
Issue number2
DOIs
StatePublished - Aug 2004

Fingerprint

Airway Extubation
Hemofiltration
Cardiopulmonary Bypass
Steroids
Nonparametric Statistics
Artificial Respiration
Control Groups
Research Ethics Committees
Methylprednisolone
Propofol
Informed Consent
Double-Blind Method
Coronary Artery Bypass
Dexamethasone
Thoracic Surgery
Ventilation
Anesthesia
Prospective Studies
Inflammation

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Hemofiltration but not steroids results in earlier tracheal extubation following cardiopulmonary bypass : A prospective, randomized double-blind trial. / Oliver, William C.; Nuttall, Gregory A.; Orszulak, Thomas A.; Bamlet, William R.; Abel, Martin D.; Ereth, Mark H.; Schaff, Hartzell V.

In: Anesthesiology, Vol. 101, No. 2, 08.2004, p. 327-339.

Research output: Contribution to journalArticle

Oliver, William C. ; Nuttall, Gregory A. ; Orszulak, Thomas A. ; Bamlet, William R. ; Abel, Martin D. ; Ereth, Mark H. ; Schaff, Hartzell V. / Hemofiltration but not steroids results in earlier tracheal extubation following cardiopulmonary bypass : A prospective, randomized double-blind trial. In: Anesthesiology. 2004 ; Vol. 101, No. 2. pp. 327-339.
@article{e7ba8754b31d48e5babd13ccfa275c17,
title = "Hemofiltration but not steroids results in earlier tracheal extubation following cardiopulmonary bypass: A prospective, randomized double-blind trial",
abstract = "Background: Activation of the inflammatory cascade is thought to account for some of the respiratory dysfunction and prolonged mechanical ventilation associated with cardiopulmonary bypass. The objective of this investigation was to identify whether perioperative steroids or hemofiltration during cardiopulmonary bypass, by their attenuation of inflammation, would reduce duration of mechanical ventilation after cardiac surgery. Methods: After Institutional Review Board approval and informed consent, 192 patients scheduled to undergo elective primary coronary artery bypass grafting or valvular replacement or repair were randomized in a double-blind prospective study into three groups. One group (Control) received saline at induction and at 6-h intervals for four doses. Another group (Hemofil) received saline and hemofiltration to obtain 27 ml/kg of hemofiltrate. The final group (Steroid) received 1 g methylprednisolone before anesthesia induction and then 4 mg of dexamethasone at 6-h intervals for four doses. All patients underwent normothermic cardiopulmonary bypass and received propofol for postoperative sedation. Separate two-sample comparisons were performed to compare each experimental group versus the control group using the Wilcoxon rank sum test for continuous variables and Fisher exact test for categorical variables. In all cases, two-tailed P values ≤ 0.05 were considered statistically significant. Results: The median time until the patient reached an intermittent mandatory ventilation of 4/min (258.5 versus 385.0 min, respectively; P = 0.02) and tracheal extubation (352.0 versus 518.0 min; P = 0.03) was significantly reduced for group Hemofil but no different for Steroid compared to Control. Conclusions: Hemofiltration and steroids are both previously reported to attenuate the inflammatory response but only hemofiltration reduced time to tracheal extubation for adults after cardiopulmonary bypass in this study.",
author = "Oliver, {William C.} and Nuttall, {Gregory A.} and Orszulak, {Thomas A.} and Bamlet, {William R.} and Abel, {Martin D.} and Ereth, {Mark H.} and Schaff, {Hartzell V}",
year = "2004",
month = "8",
doi = "10.1097/00000542-200408000-00013",
language = "English (US)",
volume = "101",
pages = "327--339",
journal = "Anesthesiology",
issn = "0003-3022",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Hemofiltration but not steroids results in earlier tracheal extubation following cardiopulmonary bypass

T2 - A prospective, randomized double-blind trial

AU - Oliver, William C.

AU - Nuttall, Gregory A.

AU - Orszulak, Thomas A.

AU - Bamlet, William R.

AU - Abel, Martin D.

AU - Ereth, Mark H.

AU - Schaff, Hartzell V

PY - 2004/8

Y1 - 2004/8

N2 - Background: Activation of the inflammatory cascade is thought to account for some of the respiratory dysfunction and prolonged mechanical ventilation associated with cardiopulmonary bypass. The objective of this investigation was to identify whether perioperative steroids or hemofiltration during cardiopulmonary bypass, by their attenuation of inflammation, would reduce duration of mechanical ventilation after cardiac surgery. Methods: After Institutional Review Board approval and informed consent, 192 patients scheduled to undergo elective primary coronary artery bypass grafting or valvular replacement or repair were randomized in a double-blind prospective study into three groups. One group (Control) received saline at induction and at 6-h intervals for four doses. Another group (Hemofil) received saline and hemofiltration to obtain 27 ml/kg of hemofiltrate. The final group (Steroid) received 1 g methylprednisolone before anesthesia induction and then 4 mg of dexamethasone at 6-h intervals for four doses. All patients underwent normothermic cardiopulmonary bypass and received propofol for postoperative sedation. Separate two-sample comparisons were performed to compare each experimental group versus the control group using the Wilcoxon rank sum test for continuous variables and Fisher exact test for categorical variables. In all cases, two-tailed P values ≤ 0.05 were considered statistically significant. Results: The median time until the patient reached an intermittent mandatory ventilation of 4/min (258.5 versus 385.0 min, respectively; P = 0.02) and tracheal extubation (352.0 versus 518.0 min; P = 0.03) was significantly reduced for group Hemofil but no different for Steroid compared to Control. Conclusions: Hemofiltration and steroids are both previously reported to attenuate the inflammatory response but only hemofiltration reduced time to tracheal extubation for adults after cardiopulmonary bypass in this study.

AB - Background: Activation of the inflammatory cascade is thought to account for some of the respiratory dysfunction and prolonged mechanical ventilation associated with cardiopulmonary bypass. The objective of this investigation was to identify whether perioperative steroids or hemofiltration during cardiopulmonary bypass, by their attenuation of inflammation, would reduce duration of mechanical ventilation after cardiac surgery. Methods: After Institutional Review Board approval and informed consent, 192 patients scheduled to undergo elective primary coronary artery bypass grafting or valvular replacement or repair were randomized in a double-blind prospective study into three groups. One group (Control) received saline at induction and at 6-h intervals for four doses. Another group (Hemofil) received saline and hemofiltration to obtain 27 ml/kg of hemofiltrate. The final group (Steroid) received 1 g methylprednisolone before anesthesia induction and then 4 mg of dexamethasone at 6-h intervals for four doses. All patients underwent normothermic cardiopulmonary bypass and received propofol for postoperative sedation. Separate two-sample comparisons were performed to compare each experimental group versus the control group using the Wilcoxon rank sum test for continuous variables and Fisher exact test for categorical variables. In all cases, two-tailed P values ≤ 0.05 were considered statistically significant. Results: The median time until the patient reached an intermittent mandatory ventilation of 4/min (258.5 versus 385.0 min, respectively; P = 0.02) and tracheal extubation (352.0 versus 518.0 min; P = 0.03) was significantly reduced for group Hemofil but no different for Steroid compared to Control. Conclusions: Hemofiltration and steroids are both previously reported to attenuate the inflammatory response but only hemofiltration reduced time to tracheal extubation for adults after cardiopulmonary bypass in this study.

UR - http://www.scopus.com/inward/record.url?scp=3342993234&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=3342993234&partnerID=8YFLogxK

U2 - 10.1097/00000542-200408000-00013

DO - 10.1097/00000542-200408000-00013

M3 - Article

C2 - 15277915

AN - SCOPUS:3342993234

VL - 101

SP - 327

EP - 339

JO - Anesthesiology

JF - Anesthesiology

SN - 0003-3022

IS - 2

ER -