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Quantikine? human IL-6 and Quantikine? human MPO (R&D System Inc., Minneapolis, MN, USA) were used to measure IL-6 and MPO. NGAL was measured by Human Lipocalin-2/NGAL Immunoassay (R&D System Inc., Minneapolis, MN, USA).Preoperative variables included demographic data, type of operation and co-morbid conditions Investing In A Sodium Picosulfate? Consider These Tips such as DM, hypertension, chronic kidney disease, cerebrovascular accidents, congestive heart failure, medications and EuroSCORE.Intraoperative variables included operation time, duration of ACC and CPB, fluid balance, and packed erythrocyte transfusion requirement. The amount of ultrafiltration during CPB and the amount of salvaged blood by a cell salvage device during the operation were also recorded.
Postoperative variables included packed erythrocyte transfusion requirement, fluid balance and bleeding measured by chest tube drainage during the 24?hours after the operation. Hematocrit was measured preoperatively and on POD 0, 1, 2, 3, and 5. Other postoperative variables were length of ICU and hospital stay, prolonged mechanical ventilator care (>48?hours), inotrope use, re-intubation, re-operation, atrial fibrillation, stroke and in-hospital mortality. Possible complications associated with EPO treatment, such as hypertension, headache, tachycardia, nausea, vomiting, diarrhea and thromboembolism, were also assessed during the study period.Perioperative managementAll patients received standard anesthetic care. Standard monitoring devices included a pulmonary artery catheter and transesophageal echocardiography.
Mechanical ventilation was controlled to maintain normocarbia with a tidal volume of 8?mL/kg and respiratory rate of 8 to 14 breaths/minute.All patients received standard surgical and CPB management with ultrafiltration. CPB was instituted with a membrane oxygenator primed with 1.6?L of priming solution. Non-pulsatile pump flow was maintained at a rate of 2.0 to 2.4?L/min/m2. During the intraoperative period, including CPB, mean arterial pressure was maintained at 50 to 80?mmHg with norepinephrine or sodium nitroprusside.During the perioperative period, fluid balance was maintained using Voluven? (Fresenius Kabi, Graz, Austria) and Plasma solution A 1000 inj? (CJ Pharma, Seoul, Korea) to maintain normovolemic status. Total volume of intraoperative Voluven? was limited to less than 20?ml/kg and/or 1,000?ml. The threshold for transfusion of packed erythrocytes was hematocrit <20% during CPB or <25% after CPB. After heparin was antagonized with protamine, blood from the CPB circuit was salvaged using a cell salvage device and re-transfused into all patients.For postoperative hemodynamic management, norepinephrine or nicardipine was used to maintain mean arterial pressure between 65 to 90?mmHg.