Point of Care Management of Perioperative Bleeding or Coagulopathy and Volume Replacement Strategy with Albumin 5% Seems to Reduce Primary Graft Disfunction after Lung Transplantation (Preliminary Results)

Abstract

Purpose Primary Graft Dysfunction (PGD) is the most common complication during the first 72 hours after lung transplant. Amount of perioperative blood loss and blood product administration may be some of the causes. Intravascular volume during surgery and in ICU is usually maintained by the administration of crystalline and colloids solutions and by administration of fresh frozen plasma (FFP) due to coagulopathy. In the field of the allogenic ischemic organ FFP essentially becomes another allogenic material and can cause undesired immunomodulation and contribute to the development of PGD. Nowadays point of care (POC) management of coagulopathy and bleeding is available using methods such as thromboelastometry (ROTEM), platelet function analyzer (PFA 200) and agregometer (Multiplate) which contribute to the optimalization of blood products and coagulation factors administration. The purpose of this study is to find out if POC management of perioperative bleeding and coagulopathy can reduce postoperative PGD development and length of artificial ventilation. Methods 18 patients undergoing bilateral lung transplantation were randomized into 2 groups. In the first group (9 subj) the management of perioperative bleeding or coagulopathy and volume replacement strategy were based on clinical experience of the anesthesiologist - standard approach. In the second group (9 subj) the management of perioperative bleeding and coagulopathy was based on the results of POC methods. Albumin 5% solution was preferably used for volume replacement therapy. Results In the POC management group PGD development, length of artificial ventilation and langht of stay was significantly reduced. Conclusion POC management of perioperative bleeding or coagulopathy and volume replacement strategy with Albumin 5% significantly reduce PGD development and decrease length of stay and artificial ventilation.