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- W3048296520 abstract "<h3>Objectives</h3> With the exception of 0.9% saline, little is known about factors that may contribute to increased serum chloride concentration (S<sub>Cl</sub><sup>−</sup>) in patients undergoing cardiac surgery. For the present study, the authors sought to characterize the association between administered chloride load from intravenous fluid and other perioperative variables, with peak perioperative S<sub>Cl</sub><sup>−</sup>. <h3>Design</h3> Secondary analysis of data from a previously published controlled clinical trial in which patients were assigned to a chloride-rich or chloride-limited perioperative fluid strategy (NCT02020538). <h3>Setting</h3> Academic medical center. <h3>Participants</h3> The study comprised 1,056 adult patients with normal preoperative S<sub>Cl</sub><sup>−</sup> undergoing cardiac surgery. <h3>Interventions</h3> None <h3>Measurements and Main Results</h3> Peak perioperative S<sub>Cl</sub><sup>−</sup> and hyperchloremia, defined as peak S<sub>Cl</sub><sup>−</sup> >110 mmol/L, were selected as co-primary endpoints. Regression modeling identified factors independently associated with these endpoints. Mean (standard deviation) peak perioperative S<sub>Cl</sub><sup>−</sup> was 114 (5) mmol/L, and hyperchloremia occurred in 824 (78.0%) of the cohort. In addition to administered volume of 0.9% saline, multivariate linear and logistic regression modeling consistently associated preoperative S<sub>Cl</sub><sup>−</sup> (regression coefficient 0.5; 95% confidence interval [CI] 0.4-0.6 mmol/L; odds ratio 1.60; 95% CI 1.41-1.82 per 1 mmol/L increase) and cardiopulmonary bypass duration (regression coefficient 0.1; 95% CI 0.1-0.2 mmol/L; odds ratio 1.12; 95% CI 1.06-1.19 per 10 minutes) with both co-primary outcomes. Multivariate modeling only explained approximately 50% of variability in peak S<sub>Cl</sub><sup>−</sup>. <h3>Conclusions</h3> The present study's data identified an association for both 0.9% saline administration and other nonfluid variables with peak perioperative S<sub>Cl</sub><sup>−</sup> and hyperchloremia. Stand-alone strategies to limit administration of chloride-rich intravenous fluid may have limited ability to prevent hyperchloremia in this setting." @default.
- W3048296520 created "2020-08-13" @default.
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- W3048296520 creator A5015504359 @default.
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- W3048296520 date "2021-05-01" @default.
- W3048296520 modified "2023-09-24" @default.
- W3048296520 title "Peak Serum Chloride and Hyperchloremia in Patients Undergoing Cardiac Surgery Is Not Explained by Chloride-Rich Intravenous Fluid Alone: A Post-Hoc Analysis of the LICRA Trial" @default.
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- W3048296520 doi "https://doi.org/10.1053/j.jvca.2020.07.085" @default.
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