Fluid balance and pulmonary functions during and after coronary artery bypass surgery: Ringer's acetate compared with dextran, polygeline, or albumin

Abstract

The effects on fluid balance, pulmonary functions and economics were evaluated in a randomized comparison of one colloid free and three colloid containing fluid regimens, for 48 hours during and after coronary artery bypass (CAB) surgery. A standard regimen for anaesthesia, extracorporeal circulation and monitoring was used. Only Ringer's acetate (RAc) was used as priming solution for extracorporeal circulation. Forty patients were randomized to receive either RAc, polygeline 35 mg.ml-1 (Haemaccel), dextran 70 (Macrodex) 60 mg.ml-1, or albumin 40 mg.ml-1 in saline whenever fluid volume was needed to stabilize haemodynamics. At the end of the operation, fluid retention was significantly lower in patients receiving polygeline and dextran 70, compared with patients receiving RAc. At 48 hours, however, there were no differences in cumulative fluid balance. Patients in the colloid groups postoperatively had a higher serum colloid osmotic pressure (s-COP), but a higher net lung capillary filtration pressure (delta P) only on the second postoperative day than the RAc group. However, this did not adversely affect intrapulmonary venous admixture, arterial oxygen tension, or time on respirator in the RAc group compared with the colloid groups. The most expensive colloid fluid regimen (albumin) cost about 230 US$ more per patient than the RAc fluid regimen. We conclude that Ringer's acetate for volume replacement to stabilize haemodynamics during and after CAB surgery is associated with increased fluid retention only during the intraoperative period, compared with dextran 70 or polygeline, and with a lower serum colloid osmotic pressure and net lung capillary filtration pressure postoperatively, compared with all three colloid groups. This does not affect pulmonary functions adversely.(ABSTRACT TRUNCATED AT 250 WORDS)

Post‐operative volume therapy in cardiac surgery: effects on hemostatic and circulatory variables

“…The findings of a similar fluid balance diverge from those in an investigation (Tølløfsrud et al 1995) claiming that a larger volume of crystalloids than of colloids is necessary to maintain hemodynamics (CI, PCWP, CVP). The Tølløfsrud group used colloids intraoperatively, and fluid retention was greater in the crystalloid group only at the end of surgery, but not at 48 hours postoperatively.…”

“…Lowell and co-workers (1990) demonstrated that after major surgery those patients with a body weight increase of over 20% died, but a moderate fluid overload postoperatively could improve the DO 2 (Arkilic et al 2003) as well as the microcirculation in critically ill patients (Lang et al 2003). Nevertheless, many studies report a better physiological outcome using the optimal model of volume replacement (Tølløfsrud et al 1995, Lobo et al 2002, Brandstrup et al 2003, Nisanevich et al 2005). …”

The Effect of HES (130/0.4) Usage as the Priming Solution on Renal Function in Children Undergoing Cardiac Surgery

“…16,17 Several studies that used albumin and HES as priming solutions indicate that conservation of colloid osmotic pressure during CPB reduced the fluid amount accumulated between the tissues. 18 Also, colloidal priming solution usage reduced the total blood volume and intraoperative fluid requirement. 17 Tiryakioglu and colleagues 19 compared the RL and HES 130/0.4 usage as the priming solution on adult patients and observed that BUN and serum creatinine levels were higher in the HES 130/0.4 group at postoperative 24th hour.…”

The Colloid Crystalloid Debate: Are We Asking the Right Question?

“…[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] The pooled relative risk (RR) was 1.53 (95% CI 1.08-2.13). The albumin treated group carried a risk of death 6% higher than the crystalloid vs.…”

“…6,15,16,21,[24][25][26] Four trials used modified gelatins with 95 randomized patients, and the pooled RR was 0.50 (95% CI 0.08-3.03). 6,19,27,28 Eight trials including 668 patients compared dextran with crystalloid and yielded a pooled RR of 1.24 (95% CI 0.94-1.65) (Figure 1). 19,[29][30][31][32][33][34][35] …”