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Wiley InterScience

Acta Anaesthesiologica Scandinavica

Early View (Articles online in advance of print)

Published Online: 29 Oct 2009

Official Publication of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine

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Infusion of hypertonic saline/starch during cardiopulmonary bypass reduces fluid overload and may impact cardiac function

V. L. KVALHEIM ¹ , M. FARSTAD ² , E. STEIEN ² , A. MONGSTAD ¹ , B. A. BORGE ³ , P. M. KVITTING ¹ and P. HUSBY ⁴

¹ Section for Cardiothoracic Surgery, Department of Heart Disease, University of Bergen, Haukeland University Hospital, Bergen, Norway, Departments of ² Anesthesia and Intensive Care, and ³ Biomedicine, University of Bergen, Haukeland University Hospital, Bergen, Norway, and ⁴ Institute of Surgical Sciences, University of Bergen, Haukeland University Hospital, Bergen, Norway

Correspondence to Address:
Marit Farstad
Department of Anesthesia and Intensive Care
University of Bergen
Haukeland University Hospital
5021 Bergen
Norway
e-mail: fars@helse-bergen.no

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 PaO₂/FiO₂ 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.

Accepted for publication 15 September 2009

DIGITAL OBJECT IDENTIFIER (DOI)

10.1111/j.1399-6576.2009.02156.x About DOI