PMID: 30153782Aug 30, 2018Paper

Fluid resuscitation associated with elevated angiopoietin-2 and length of mechanical ventilation after cardiac surgery

Critical Care and Resuscitation : Journal of the Australasian Academy of Critical Care Medicine
R L ParkeAndrew D Bersten

Abstract

Fluid restriction in patients with acute respiratory distress syndrome increases ventilator-free days while lowering plasma angiopoietin-2 (Ang-2), a marker of pulmonary endothelial injury. We hypothesised that fluid resuscitation may lead to endothelial injury after cardiac surgery and analysed Ang-2, angiopoietin-1 (Ang-1) and phospholipase A2 (PLA2) levels and the impact of fluid management on ventilation time. Patients enrolled in a single-centre, prospectively randomised interventional study of liberal or conservative fluid resuscitation strategy had plasma Ang-2, Ang-1 and PLA2 levels measured at baseline (pre-operative), 6 and 24 hours after commencement of cardiopulmonary bypass, and analysed by linear mixed models as liberal v conservative (intention to treat) or high v low fluid group (actual treatment, ≥ 3250 mL of fluid administered), and further subclassified as EuroSCORE (European System for Cardiac Operative Risk Evaluation) II ≥ 0.9 or < 0.9. Over 9 months, 144 patients were randomly allocated to either liberal (n =74) or conservative (n =70) fluid. Patients in the liberal fluid arm tended to an increased Ang-2 (P =0.12) and had higher PLA2 levels (P =0.03). Based on actual fluid administered, Ang-2 levels were ...Continue Reading

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