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J Thorac Cardiovasc Surg 2004;127:525-534
© 2004 The American Association for Thoracic Surgery

Cardiopulmonary support and physiology

Can the use of methylprednisolone, vitamin C, or {alpha}-trinositol prevent cold-induced fluid extravasation during cardiopulmonary bypass in piglets?

M. Farstad, MDa, J. K. Heltne, MD, PhDa, S. E. Rynning, MD, PhDb, H. Onarheim, MD, PhDa, A. Mongstad, RPb, F. Eliassen, RPb, P. Husby, MD, PhDa,*

a Department of Anesthesia and Intensive Care, University of Bergen, Haukeland University Hospital, Bergen, Norway
b Department of Heart Disease, University of Bergen, Haukeland University Hospital, Bergen, Norway

Received for publication January 27, 2003; revisions received April 1, 2003; accepted for publication April 21, 2003.

* Address for reprints: P. Husby, MD, PhD, Department of Anesthesia and Intensive Care, Haukeland University Hospital, N-5021 Bergen, Norway
phus{at}haukeland.no

OBJECTIVE: Hypothermic cardiopulmonary bypass is associated with capillary fluid leakage, resulting in edema and occasionally organ dysfunction. Systemic inflammatory activation is considered responsible. In some studies methylprednisolone has reduced the weight gain during cardiopulmonary bypass. Vitamin C and {alpha}-trinositol have been demonstrated to reduce the microvascular fluid and protein leakage in thermal injuries. We therefore tested these three agents for the reduction of cold-induced fluid extravasation during cardiopulmonary bypass.

METHODS: A total of 28 piglets were randomly assigned to four groups of 7 each: control group, high-dose vitamin C group, methylprednisolone group, and {alpha}-trinositol-group. After 1 hour of normothermic cardiopulmonary bypass, hypothermic cardiopulmonary bypass was initiated in all animals and continued to 90 minutes. The fluid level in the extracorporeal circuit reservoir was kept constant at the 400-mL level and used as a fluid gauge. Fluid needs, plasma volume, changes in colloid osmotic pressure in plasma and interstitial fluid, hematocrit, and total water contents in different tissues were recorded, and the protein masses and the fluid extravasation rate were calculated.

RESULTS: Hemodilution was about 25% after start of normothermic cardiopulmonary bypass. Cooling did not cause any further changes in hemodilution. During steady-state normothermic cardiopulmonary bypass, the fluid need in all groups was about 0.10 mL/(kg · min), with a 9-fold increase during the first 30 minutes of cooling (P < .001). This increased fluid need was due mainly to increased fluid extravasation from the intravascular to the interstitial space at a mean rate of 0.6 mL/(kg · min) (range 0.5-0.7 mL/[kg · min]; P < .01) and was reflected by increased total water content in most tissues in all groups. The albumin and protein masses remained constant in all groups throughout the study.

CONCLUSION: Pretreatment with methylprednisolone, vitamin C, or {alpha}-trinositol was unable to prevent the increased fluid extravasation rate during hypothermic cardiopulmonary bypass. These findings, together with the stability of the protein masses throughout the study, support the presence of a noninflammatory mechanism behind the cold-induced fluid leakage seen during cardiopulmonary bypass.




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