Crystalloids vs Albumin Prime Solution and Postoperative Pulmonary Complications
Condition: Postoperative Complications
MeSH terms: Postoperative Complications
Study type: Observational

Summary: 
      In 2019, the investigators initiated a new priming fluid therapy strategy in the
      cardiopulmonary bypass (CPB) machine for patients undergoing pulmonary endarterectomy
      surgery. It consisted in a transition from a "pure" primarly balanced crystalloid priming
      fluid strategy to a 4% human albumin priming fluid-strategy in addition to a low volume of
      balanced crystalloid solution. The rationale was the theoritical assumption that albumin
      leads to better intravascular volume expansion compared to crystalloid and therefore could
      reduce overall volume requirement during surgery and consequently potentially decrease the
      incidence of postoperative pulmonary complications. The objective of this propensity-matched
      study was to evaluate the effectiveness of this intervention
    

Detailed description: 
      Intravenous fluid is usually needed (and sometime in important amount) to increase
      intravascular volume during cardiac surgery and to prime the cardiopulmonary bypass (CPB)
      circuit. In this context, albumin has been frequently used as the ideal fluid choice.
      Although albumin has the disadvantage to be much more expensive than crystalloids and not to
      be free from immunological reactions, this solution provides a more sustained volume effect
      that a similar volume of crystalloid which may result in smaller volumes of resuscitation
      fluid being administered. It also better preserves the on-bypass oncotic pressure and reduce
      extravascular lung water. These considerations are important especially during pulmonary
      thromboendarterectomy surgery (PTE), a high-risk procedure which aims to resect
      thromboembolic material. Reperfusion lung injury (RLI) and/or acute respiratory distress
      syndrome (ARDS), are the most encountered postoperative pulmonary complications and are
      significant risks factors of morbi-mortality. As data suggest that RLI and ARDS are
      high-permeability phenomenon, cautious is required to avoid fluid accumulation/overload
      during this complex procedure. In addition, this surgical procedure has a relatively high CPB
      duration which can induce a systemic inflammatory response syndrome, damage the endothelial
      glycocalyx and vascular barrier where crystalloids may extravagates and accumulates in the
      lungs. On the contrary, albumin solution used during the priming of CPB can favorably
      preserve oncotic pressure, have a protective effect on endothelial glycocalyx and better
      maintain vascular barrier competence, preventing interstitial edema and potential pulmonary
      complications.

      In March 2019, the investigators initiated a new priming fluid policy strategy aiming at
      replacing our traditional pure crystalloid fluid administration for an albumin one in order
      to decrease the relatively high-rate of pulmonary complications observed in the investigators
      patients.

      The objective of this propensity-matched study was to evaluate the effectiveness of this
      intervention
    

Intervention name(s): implementation of albumin solution in the priming of the cardiopulmonary bypass machine
Intervention type(s): Behavioral
Intervention description(s): In March 2019, the investigators initiated a new priming fluid policy strategy aiming at replacing our traditional pure crystalloid fluid administration for an albumin one in order to decrease the relatively high-rate of observed pulmonary complications
Observational model: Case-Control
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        All consecutive patients undergoing pulmonary endarterectomy surgery from 2018 to 2019 ( a
        two years study period)