• Sirlei Cristina da Silva, Fernanda Marciano Consolim-Colombo, Renata Gomes Rodrigues, Fábio Antonio Gaiotto, Ludhmila Abrahão Hajjar, MoysésRosa Maria AffonsoRMANephrology, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil., and EliasRosilene MottaRMNephrology, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil.Universidade Nove de Julho (UNINOVE), São Paulo, Brazil..
• Instituto do Coração, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil. sirlei.silva@hc.fm.usp.br.
• BMC Anesthesiol. 2020 Mar 7; 20 (1): 60.

BackgroundFluid overload is a risk factor for morbidity, mortality, and prolonged ventilation time after surgery. Patients on maintenance hemodialysis might be at higher risk. We hypothesized that fluid accumulation would be directly associated with extended ventilation time in patients on hemodialysis, as compared to patients with chronic kidney disease not on dialysis (CKD3-4) and patients with normal renal function (reference group).MethodsThis is a prospective observational study that included patients submitted to isolated and elective coronary artery bypass surgery, divided in 3 groups according to time on mechanical ventilation: < 24 h, 24-48 h and > 48 h. The same observer followed patients daily from the surgery to the hospital discharge. Cumulative fluid balance was defined as the sum of daily fluid balance over the first 5 days following surgery.ResultsPatients requiring more than 48 h of ventilation (5.3%) had a lower estimated glomerular filtration rate, were more likely to be on maintenance dialysis, had longer anesthesia time, needed higher dobutamine and noradrenaline infusion following surgery, and had longer hospitalization stay. Multivariate analysis revealed that the fluid accumulation, scores of sequential organ failure assessment in the day following surgery, and the renal function (normal, chronic kidney disease not on dialysis and maintenance hemodialysis) were independently associated with time in mechanical ventilation. Among patients on hemodialysis, the time from the surgery to the first hemodialysis session also accounted for the time on mechanical ventilation.ConclusionsFluid accumulation is an important risk factor for lengthening mechanical ventilation, particularly in patients on hemodialysis. Future studies are warranted to address the ideal timing for initiating dialysis in this scenario in an attempt to reduce fluid accumulation and avoid prolonged ventilation time and hospital stay.

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