This is an open-label, prospective crossover randomized controlled trial to investigate wether TACO is solely hydrostatic pressure overload or arises from a combination of hydrostatic pressure overload and capillary leakage, by investigating the difference in change in static pressure parameters (PCWP), dynamic volume parameters (PICCO) as indirect measurements of volume status and capillary leakage after autologous transfusion or saline infusion. The investigators will estimate effective circulating volume following autologous transfusion or saline infusion. Furthermore, the investigators will investigate the effect of fluid loading on the microcirculation.
Coronary arterial bypass grafting surgery patients with reduced left ventricular function will be allocated to either infusion of 300mL saline with a subsequent autologous RBC (cell saver) transfusion of 300 mL at a rate of 10mL/min, or the same in the reversed order. Prior to start of the intervention, 15 minutes following start of infusion and a the end of infusion, the investigators will measure right-ventricular pressure and wedge pressure (PCWP), as well as extravascular lung water index (EVLWI) and CO estimation through PICCO® and Pulmonary Artery Catheter. The investigators will identify fluid responsiveness by performing a passive leg raise test (PLR). The investigators aim to measure total vessel density (TVD), perfused vessel density (PVD), proportion of perfused vessels (PPV), microvascular flow index (MFI), and blood vessel diameters (Øbv) from the oral microcirculation by CytoCam microscope system. The investigators will estimate the effective circulating blood and plasma volume through dilutional infusion of indocyanine green prior to initial infusion, between and at the end of subsequent infusion.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
BASIC_SCIENCE
Masking
DOUBLE
Enrollment
16
Autologous RBC transfusion 300ml 10 ml/min
Saline transfusion 300ml 10ml/min
Academisch Medisch Centrum - Universiteit van Amsterdam
Amsterdam, Netherlands
Hydrostatic pressure overload
Hydrostatic pressure overload defined as delta pulmonary capillary wedge pressure
Time frame: 1 hour
Capillary leakage
Capillary leakage defined as delta extra vascular lung water index
Time frame: 1 hour
Cardiac output
Volume overload measured by cardiac output
Time frame: 1 hour
Mean arterial pressure
Volume overload measured by mean arterial pressure
Time frame: 1 hour
Pulse pressure variation
Volume overload measured by pulse pressure variation
Time frame: 1 hour
Stroke volume variation
Volume overload measured by stroke volume variation
Time frame: 1 hour
Extra vascular lung water index
Volume overload measured by extra vascular lung water index
Time frame: 1 hour
Systemic vascular resistance
Volume overload measured by systemic vascular resistance
Time frame: 1 hour
Colloid osmotic pressure
Colloid osmotic pressure measured by membrane colloid osmometer
Time frame: 1 hour
Estimated circulating volume
Estimated circulating blood volume measured by indocyanine green
Time frame: 1 hour
Estimated circulating volume
Estimated circulating plasma volume measured by indocyanine green
Time frame: 1 hour
Microcirculation
Total vessel density in the sublingual microcirculation measured by Cytocam
Time frame: 1 hour
Microcirculation
Perfused vessel density in the sublingual microcirculation measured by Cytocam
Time frame: 1 hour
Microcirculation
Proportion of perfused vessels in the sublingual microcirculation measured by Cytocam
Time frame: 1 hour
Microcirculation
Microvascular flow index in the sublingual microcirculation measured by Cytocam
Time frame: 1 hour
Microcirculation
Blood vessel diameters in the sublingual microcirculation measured by Cytocam
Time frame: 1 hour
Fluid responsiveness
Fluid responsiveness defined by Passive Leg Raise test (increase in cardiac output \> 10%)
Time frame: 1 hour
TACO
Transfusion associated circulatory overload criteria 6 hours after infusion of autologous blood transfusion
Time frame: 6 hours
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