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Infusion of hypertonic saline/starch during cardiopulmonary bypass reduces fluid overload and may impact cardiac function.
Acta Anaesthesiol Scand. 2010 Apr; 54(4):485-93.AA

Abstract

OBJECTIVE

Peri-operative fluid accumulation resulting in myocardial and pulmonary tissue edema is one possible mechanism behind post-operative cardiopulmonary dysfunction. This study aimed to confirm an improvement of cardiopulmonary function by reducing fluid loading during an open-heart surgery.

MATERIALS AND METHODS

Forty-nine elective CABG patients were randomized to an intraoperative infusion of hypertonic saline/hydroxyethyl starch (HSH group) or Ringer's solution (CT group). Both groups received 1 ml/kg/h of the study solution for 4 h after baseline values were obtained (PICCO transpulmonary thermodilution technique). Net fluid balance (NFB), hemodynamic and laboratory parameters were measured.

RESULTS

NFB was four times higher in the CT group compared with the HSH group during the first 6 h post-operatively. The total fluid gain until the next morning was lower in the HSH group, 2993.9 (938.6) ml, compared with the CT group, 4298.7 (1059.3) ml (P<0.001). Normalized values (i.e., %-changes from the baseline) of the cardiac index and the global end diastolic volume index increased post-operatively in both groups. Both parameters were significantly higher at 6 h in the HSH group compared with CT group (P=0.002 and 0.005, respectively). Normalized values of the intrathoracic blood volume index were lower in the HSH group at 6 h post-operatively when compared with the CT group. The PaO(2)/FiO(2) ratio decreased similarly in both groups early post-operatively, but recovery tended to be more rapid in the HSH group. Although serum-sodium and serum-chloride levels were significantly higher in the HSH group, the acid-base parameters remained similar and within the normal range.

CONCLUSIONS

An intraoperative infusion of HSH during cardiac surgery contributes to reduced fluid loading and an improvement in the post-operative cardiac performance. No adverse effects of the HSH infusion were observed.

Authors+Show Affiliations

Department of Heart Disease, University of Bergen, Haukeland University Hospital, Bergen, Norway.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

19878097

Citation

Kvalheim, V L., et al. "Infusion of Hypertonic Saline/starch During Cardiopulmonary Bypass Reduces Fluid Overload and May Impact Cardiac Function." Acta Anaesthesiologica Scandinavica, vol. 54, no. 4, 2010, pp. 485-93.
Kvalheim VL, Farstad M, Steien E, et al. Infusion of hypertonic saline/starch during cardiopulmonary bypass reduces fluid overload and may impact cardiac function. Acta Anaesthesiol Scand. 2010;54(4):485-93.
Kvalheim, V. L., Farstad, M., Steien, E., Mongstad, A., Borge, B. A., Kvitting, P. M., & Husby, P. (2010). Infusion of hypertonic saline/starch during cardiopulmonary bypass reduces fluid overload and may impact cardiac function. Acta Anaesthesiologica Scandinavica, 54(4), 485-93. https://doi.org/10.1111/j.1399-6576.2009.02156.x
Kvalheim VL, et al. Infusion of Hypertonic Saline/starch During Cardiopulmonary Bypass Reduces Fluid Overload and May Impact Cardiac Function. Acta Anaesthesiol Scand. 2010;54(4):485-93. PubMed PMID: 19878097.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Infusion of hypertonic saline/starch during cardiopulmonary bypass reduces fluid overload and may impact cardiac function. AU - Kvalheim,V L, AU - Farstad,M, AU - Steien,E, AU - Mongstad,A, AU - Borge,B A, AU - Kvitting,P M, AU - Husby,P, Y1 - 2009/10/29/ PY - 2009/11/3/entrez PY - 2009/11/3/pubmed PY - 2010/7/16/medline SP - 485 EP - 93 JF - Acta anaesthesiologica Scandinavica JO - Acta Anaesthesiol Scand VL - 54 IS - 4 N2 - OBJECTIVE: Peri-operative fluid accumulation resulting in myocardial and pulmonary tissue edema is one possible mechanism behind post-operative cardiopulmonary dysfunction. This study aimed to confirm an improvement of cardiopulmonary function by reducing fluid loading during an open-heart surgery. MATERIALS AND METHODS: Forty-nine elective CABG patients were randomized to an intraoperative infusion of hypertonic saline/hydroxyethyl starch (HSH group) or Ringer's solution (CT group). Both groups received 1 ml/kg/h of the study solution for 4 h after baseline values were obtained (PICCO transpulmonary thermodilution technique). Net fluid balance (NFB), hemodynamic and laboratory parameters were measured. RESULTS: NFB was four times higher in the CT group compared with the HSH group during the first 6 h post-operatively. The total fluid gain until the next morning was lower in the HSH group, 2993.9 (938.6) ml, compared with the CT group, 4298.7 (1059.3) ml (P<0.001). Normalized values (i.e., %-changes from the baseline) of the cardiac index and the global end diastolic volume index increased post-operatively in both groups. Both parameters were significantly higher at 6 h in the HSH group compared with CT group (P=0.002 and 0.005, respectively). Normalized values of the intrathoracic blood volume index were lower in the HSH group at 6 h post-operatively when compared with the CT group. The PaO(2)/FiO(2) ratio decreased similarly in both groups early post-operatively, but recovery tended to be more rapid in the HSH group. Although serum-sodium and serum-chloride levels were significantly higher in the HSH group, the acid-base parameters remained similar and within the normal range. CONCLUSIONS: An intraoperative infusion of HSH during cardiac surgery contributes to reduced fluid loading and an improvement in the post-operative cardiac performance. No adverse effects of the HSH infusion were observed. SN - 1399-6576 UR - https://www.unboundmedicine.com/medline/citation/19878097/Infusion_of_hypertonic_saline/starch_during_cardiopulmonary_bypass_reduces_fluid_overload_and_may_impact_cardiac_function_ L2 - https://doi.org/10.1111/j.1399-6576.2009.02156.x DB - PRIME DP - Unbound Medicine ER -