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

Kvalheim, Venny Lise; Farstad, Mikael; Steien, E.; Mongstad, Arve; Borge, Bengt Åge Sørby; Kvitting, P.; Husby, Paul

doi:10.1111/j.1399-6576.2009.02156.x

Cited by 19 publications

(15 citation statements)

References 74 publications

(67 reference statements)

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“…The use of cardiopulmonary bypass (CPB) during heart surgery has been associated with fluid accumulation that can interfere with vital organ function. 1,2 Increased microvascular fluid filtration and/or impaired lymphatic drainage have been the reported culprits.…”

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confidence: 99%

Microvascular fluid exchange during pulsatile cardiopulmonary bypass perfusion with the combined use of a nonpulsatile pump and intra-aortic balloon pump

Lundemoen

Kvalheim

Mongstad

et al. 2013

The Journal of Thoracic and Cardiovascular Surgery

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confidence: 99%

Microvascular fluid exchange during pulsatile cardiopulmonary bypass perfusion with the combined use of a nonpulsatile pump and intra-aortic balloon pump

Lundemoen

Kvalheim

Mongstad

et al. 2013

The Journal of Thoracic and Cardiovascular Surgery

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“…An increase in microvascular permeability by hypothermia results in luid-and protein-shifts from the intravascular to the interstitial compartment, with formation of tissue edema that occasionally contribute to heart-, lung-and gastrointestinal organ dysfunction [5,6,14]. In the present study no luid was given during the experiments.…”

Section: Discussionmentioning

confidence: 72%

Brain changes in Hypothermia: Surface-versus Core-cooling in pigs

Morild¹

2017

J Forensic Sci Res

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The process of hypothermia in the clinical setting has been practiced for 50 years and is known for its neuroprotective properties. This paper describes histopathological changes either by an ice sludge mimicking accidental hypothermia (S-group n=7) or by endovascular core-cooling (C-group n=7). Focal infi ltrates of neutrophilic granulocytes were found in fi ve of seven brains in the S-group and in one of seven brains in the C-group. These granulocytes were found in the arachnoids, in vessels, in vessel walls, and in the cerebral cortex. Fungi, bacteria, lymphocytes or plasma were not found.This experimental study, mimicking accidental hypothermia, reported histopathologic features of aseptic infl ammation. To our knowledge, such fi ndings have not been described in hypothermic animals or humans before. We suggest that a local infl ammatory response may be triggered in such cases of hypothermia.

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“…As crystalloid solutions pass freely across the endothelial glycocalyx and underlying endothelial cells, they are evenly distributed within the extracellular fluid compartment, leaving only about one‐fifth of the administered fluid in the intravascular space (Chappell, Jacob, Hofmann‐kiefer, Conzen, & Rehm, ; Myers & Wegner, ). Administration of colloids instead of crystalloids during cardiopulmonary bypass (CPB) has, however, been reported to reduce fluid leakage and formation of oedema in both preclinical (Farstad, Kvalheim, & Husby, ) and clinical studies (Himpe, ; Kvalheim et al., ). Moreover, improved postoperative cardiac function is reported to take place if using colloids rather than crystalloids during CPB (Kvalheim et al., ).…”

Section: Introductionmentioning

confidence: 99%

Extracorporeal rewarming from experimental hypothermia: Effects of hydroxyethyl starch versus saline priming on fluid balance and blood flow distribution

Schanche

Kondratiev

Tveita

2019

Experimental Physiology

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New Findings What is the central question of this study?Mortality in accidental hypothermia patients rewarmed by extracorporeal circulation remains high. Knowledge concerning optimal fluid additions for extracorporeal rewarming is lacking, with no apparent consensus. Does colloid versus crystalloid priming have different effects on fluid balance and blood flow distribution during extracorporeal rewarming? What is the main finding and its importance?In our rat model of extracorporeal rewarming from hypothermic cardiac arrest, hydroxyethyl starch generates less tissue oedema and increases circulating blood volume and organ blood flow, compared with saline. The composition of fluid additions appears to be important during extracorporeal rewarming from hypothermia. Abstract Rewarming by extracorporeal circulation (ECC) is the recommended treatment for accidental hypothermia patients with cardiac instability. Hypothermia, along with initiation of ECC, introduces major changes in fluid homeostasis and blood flow. Scientific data to recommend best practice use of ECC for rewarming these patients is lacking, and no current guidelines exist concerning the choice of priming fluid for the extracorporeal circuit. The primary aim of this study was to compare the effects of different fluid protocols on fluid balance and blood flow distribution during rewarming from deep hypothermic cardiac arrest. Sixteen anaesthetized rats were cooled to deep hypothermic cardiac arrest and rewarmed by ECC. During cooling, rats were equally randomized into two groups: an extracorporeal circuit primed with saline or primed with hydroxyethyl starch (HES). Calculations of plasma volume (PV), circulating blood volume (CBV), organ blood flow, total tissue water content, global O2 delivery and consumption were made. During and after rewarming, the pump flow rate, mean arterial pressure, PV and CBV were significantly higher in HES‐treated compared with saline‐treated rats. After rewarming, the HES group had significantly increased global O2 delivery and blood flow to the brain and kidneys compared with the saline group. Rats in the saline group demonstrated a significantly higher total tissue water content in the kidneys, skeletal muscle and lung. Compared with crystalloid priming, the use of an iso‐oncotic colloid prime generates less tissue oedema and increases PV, CBV and organ blood flow during ECC rewarming. The composition of fluid additions appears to be an important factor during ECC rewarming from hypothermia.

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

Abstract: 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.

Cited by 19 publications

References 74 publications

Microvascular fluid exchange during pulsatile cardiopulmonary bypass perfusion with the combined use of a nonpulsatile pump and intra-aortic balloon pump

Microvascular fluid exchange during pulsatile cardiopulmonary bypass perfusion with the combined use of a nonpulsatile pump and intra-aortic balloon pump

Brain changes in Hypothermia: Surface-versus Core-cooling in pigs

Extracorporeal rewarming from experimental hypothermia: Effects of hydroxyethyl starch versus saline priming on fluid balance and blood flow distribution

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