Fluid Resuscitation after Cardiac surgery: Is Hypertonic Saline or Hyperoncotic Albumin the Future?

Abstract

Background: Over-resuscitation in post-cardiac patients is associated with significant morbidity and mortality. Accordingly, there is a growing interest in concentrated human albumin and hypertonic saline for resuscitation in cardiac patients following revascularization surgery. In this article, we will review the use of hyperosmolar fluid therapies for resuscitation in post-cardiac surgical patients from the current literature. Methods: A literature search was conducted in MEDLINE (PubMed) utilizing keywords, narrowing publications to 2010-2019. Results: Patients receiving concentrated albumin after cardiac surgery required less fluid bolus therapy, less time on vasopressors and were found to have a less positive fluid balance compared to patients receiving crystalloids. The impact on cardiac output and mean arterial pressure in those given concentrated albumin compared to crystalloid boluses was inconsistent. There was no difference in mortality in those given 20% albumin compared to crystalloids post-revascularization. Hypertonic saline showed some positive immunomodulatory effects in patients post-revascularization. Studies identifying the impact of hypertonic saline on fluid balance and mortality compared to normal saline in patients following revascularization surgery are on-going. Conclusions: In this analysis, publications on resuscitation with hyperoncotic albumin and hypertonic saline in patients post-revascularization surgery were reviewed. While there is data in support of using these alternative fluid therapies in other critically ill patient populations, the limited literature in support of using concentrated albumin and hypertonic saline for resuscitation in following cardiac surgery is equivocal.