Abstract
In patients with intraoperative massive bleeding, the effects of fluid and blood volume on postoperative pulmonary edema are uncertain. Patients with intraoperative massive bleeding who had undergone a non-cardiac surgery in five hospitals were enrolled in this study. We evaluated the association of postoperative pulmonary edema risk and intra- and post-operatively administered fluid and blood volumes in patients with intraoperative massive bleeding. In total, 2090 patients were included in the postoperative pulmonary edema analysis, and 300 patients developed pulmonary edema within 72 h of the surgery. The postoperative pulmonary edema with hypoxemia analysis included 1660 patients, and the condition occurred in 161 patients. An increase in the amount of red blood cells transfused per hour after surgery increased the risk of pulmonary edema (hazard ratio: 1.03; 95% confidence interval: 1.01–1.05; p = 0.013) and the risk of pulmonary edema with hypoxemia (hazard ratio: 1.04; 95% confidence interval: 1.01–1.07; p = 0.024). An increase in the red blood cells transfused per hour after surgery increased the risk of developing pulmonary edema. This increase can be considered as a risk factor for pulmonary edema.
Highlights
Massive bleeding during surgery can be fatal in the operating room and increases postoperative mortality [1]
The postoperatively administered total fluid and the postoperative red blood cells (RBCs) per hour showed significant associations with postoperative pulmonary edema with hypoxemia
Through time-varying Cox regression, it was shown that the total amount of fluid administered after surgery and the amount of RBCs administered per hour were associated with an increased postoperative risk for pulmonary edema, both with and without hypoxemia
Summary
Massive bleeding during surgery can be fatal in the operating room and increases postoperative mortality [1]. Large volumes of fluid and blood, administered to compensate for the loss thereof, can result in fluid overload. Fluid overload, which is associated with increased hydrostatic pressure resulting in left ventricular dysfunction, is the most common cause of postoperative pulmonary edema [2]. Transfusions following massive bleeding can cause coagulopathies, acid–base abnormalities, hypothermia, and transfusion-related acute lung injury [3,4,5,6]. These complications of massive transfusions may be related to pulmonary edema [7,8,9,10].
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