Cardiopulmonary bypass with modified fluid gelatin and heparin-coated circuits

Abstract

We have assessed the efficacy of cardiopulmonary bypass (CPB) using normal colloid oncotic pressure (COP) in a randomized, controlled study of 20 patients undergoing elective coronary artery surgery using heparin-coated circuits. For CPB, we used either crystalloid priming 1650 ml (n = 10) or colloid priming 1650 ml (2.4% modified fluid gelatin, n = 10). While COP did not change during bypass in the colloid group, a decline was observed in the crystalloid group (P = 0.005). By the end of bypass, the decrease in COP compared with baseline (delta COP) was 8.5 (S.D. 1.1) mm Hg in the crystalloid group compared with 1.5 (2.1) mm Hg in the colloid group (P = 0.0001). delta COP correlated positively with fluid balance during bypass (r2 = 0.41, P = 0.002). Similar increments in complement factors C3b/c and C4b/c, tumour necrosis factor-alpha and neutrophil elastase, but not endotoxins, were found in both groups as indicators of a systemic inflammatory response. A clinical performance score composed of fluid balance, postoperative duration of intubation and the difference between rectal temperature and skin temperature was more favourable in patients treated with colloid priming (P = 0.03). Median postoperative hospital stay was 7 (range 5-16) days in the crystalloid group compared with 5 (4-8) days in the colloid group (P = 0.016). Regression analysis indicated that CPB time, fluid balance during operation and postoperative PO2/FlO2 ratio were independent factors that predicted postoperative hospital stay. From these preliminary results we conclude that in the absence of endotoxaemia, use of a normal COP during CPB with modified fluid gelatin in heparin-coated circuits resulted in an improved postoperative course an a reduction in hospital stay.

3.5% urea-linked gelatin is as effective as 6% HES 200/0.5 for volume management in cardiac surgery patients

“…Compared to crystalloids, the use of colloids offers the advantage of a lower net weight gain which could result in a shorter hospital stay. 5 Compared to the synthetic colloids, albumin has not been shown to offer any clinical advantage and its use could be associated with increased costs. 6 Gelatins and medium weight hydroxyethyl starches are the most widely used synthetic colloids in Western Europe.…”

Fluid and Electrolyte Therapy in Cardiac Surgery

“…Değişik başlangıç solüsyonu kompozisyonları bildiren çalışmalar olup, sonuçları birbirinden oldukça uzaktır. İyi planlanmış birkaç çalışmada başlangıç solüsyonunun etkileri araştırılmıştır (30)(31)(32)(33)(34)(35)(36)(37) . Bu çalışmalar yalnızca kristaloid kolloid karşılaştırması (30,33,34) şeklin-de değil, aynı zamanda hangi kolloid sorusuna da yanıt verecek şekildedir.…”

Infusion solutions of gelatin derivates

“…Randomizuoto kontroliuojamojo tyrimo metu P. Jansen nustatė, jog skiriant modifikuotos skystos žela-tinos ekstrakorporinės kraujotakos metu, pacientų būklė po operacijos buvo daug geresnė, pastebėtas mažesnis skysčių deficitas, trumpesnė endotrachė-jinės intubacijos trukmė po operacijos bei trumpesnis hospitalizacijos laikas lyginant su gydymu kristaloidais (32). Sudaryta specialistų grupė, analizavusi tik randomizuotus klinikinius tyrimus MEDLINE ir COCHRANE bibliotekoje skelbtus nuo 1996 iki 2002 m. nustatė, jog, palyginus įvairius koloidus, skiriamus operacinėje ekstrakorporinės kraujotakos metu, hidroksietilkrakmolo dariniai, net neviršijus saugios dozės ribos, didino kraujavimo riziką (33).…”