Pharmacological Interventions to Reduce Edema Following Cardiopulmonary Bypass: A Systematic Review and Meta-analysis

J Crit Care. 2019 Dec 10;56:63-72

To compare the effectiveness of different types of pharmacological agents to reduce organ specific edema following cardiopulmonary bypass (CPB).

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Purpose

To compare the effectiveness of different types of pharmacological agents to reduce organ specific edema following cardiopulmonary bypass (CPB).

Methods

Pubmed, Embase.com and Cochrane were searched for studies administrating a pharmacological agent before CPB. Primary outcome was postoperative edema.

Results

Forty-four studies (clinical n = 6, preclinical n = 38) fulfilled eligibility criteria. Steroids were used in most clinical studies (n = 5, 83%) and reduced postoperative edema in 4 studies, however heterogeneity precluded meta-analysis. In preclinical studies, a total of 31 different drugs were tested of which 20 (65%) reduced edema in at least one organ. Particularly neutrophil inhibitors, and modulators of coagulation or endothelial barrier reduced pulmonary edema (SMD −2.77 [−3.93, −1.61]; −1.29 [−2.12, −0.46], −2.33 [−4.69, 0.03], respectively) compared to no treatment. Reducing renal (SMD −0.91 [CI −1.65 to −0.18]), intestinal (SMD −1.98 [CI −3.92 to −0.04]) or myocardial (SMD −1.95 [CI −3.91 to −0.01]) edema following CPB required specific modulators of endothelial barrier.

Conclusion

Overall, neutrophil inhibitors and direct modulators of endothelial barrier (PAR1, Tie2 signaling) most effectively reduced edema following CPB, in particular pulmonary edema. Future research should focus on a combination of these strategies to reduce edema and assess the effect on organ function and outcome following CPB.