Volume Replacement Strategy with Albumin 5% and Bedside Coagulopathy Management Improves Cardiopulmonary Stability by Decreasing Norepinephrine Dosage and by Increasing P/F Ratio in Patients Undergoing Lung Transplantation (Preliminary Results)

Abstract

<h3>Purpose</h3> Lung transplantation is a very demanding procedure often accompanied by circulatory instability, bleeding, and postoperative development of primary graft dysfunction. Circulatory instability is treated with a combination of fluid and vasopressor support. 5% Albumin appears to be a very promising volume replacement. The use of bedside methods such as thromboelastometry (ROTEM), platelet function analyzer (PFA 200), and aggregometer (Multiplate) seems very promising to correct coagulopathy and reduce bleeding symptoms during lung transplantation. <h3>Methods</h3> Patients undergoing lung transplantation were divided into two groups. 1. POC (Point Of Care) group - 5% albumin was used almost exclusively as a volume replacement, and bedside methods (ROTEM, PFA, Multiplate) were used to correct coagulopathy. 2. nonPOC group - volume replacement and correction of coagulopathy were solved according to the clinical experience of the anesthesiologist. <h3>Results</h3> The total number of analyzed patients is 46. In the POC group, there was a significant decrease in vasopressor support of noradrenaline (p <0.05) and a significant improvement in the P/F ratio (p <0.05). The results are shown in Figures I. and II. <h3>Conclusion</h3> The perioperative approach using 5% albumin volume replacement in combination with bedside methods for diagnosis and correction of coagulopathy contributes to improved circulatory stability (the lower dose of noradrenaline) and also helps to improve lung graft function (better P / F ratio) during and after lung transplantation. The current preliminary results seem to be promising in this area and we will continue in this study in the future.