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A hyperosmolar-colloidal additive to the CPB-priming solution reduces fluid load and fluid extravasation during tepid CPB

Section for Cardiothoracic Surgery, Department of Heart Disease

M Farstad

Department of Anesthesia and Intensive Care, Haukeland University Hospital, N-5021 Bergen, Norway

O Haugen

Department of Anesthesia and Intensive Care, Haukeland University Hospital, N-5021 Bergen, Norway

H Brekke

Department of Anesthesia and Intensive Care, Haukeland University Hospital, N-5021 Bergen, Norway

A Mongstad

Section for Cardiothoracic Surgery, Department of Heart Disease

E Nygreen

Section for Cardiothoracic Surgery, Department of Heart Disease

P Husby

Department of Anesthesia and Intensive Care, Haukeland University Hospital, N-5021 Bergen, Norway paul.husby{at}kir.uib.no

Cardiopulmonary bypass(CPB) is associated with fluid overload. We hypothesized that fluid gain during CPB could be reduced by substituting parts of a crystalloid prime with 7.2% hypertonic saline and 6% poly(O-2-hydroxyethyl) starch solution (HyperHaes^®). 14 animals were randomized to a control group (Group C) or to Group H. CPB-prime in Group C was Ringer's solution. In group H, 4 ml/kg of Ringer's solution was replaced by the hypertonic saline / hydroxyethyl starch solution. After 60 min stabilization, CPB was initiated and continued for 120 min. All animals were allowed drifting of normal temperature (39.0°C) to about 35.0°C. Fluid was added to the CPB circuit as needed to maintain a 300-ml level in the venous reservoir. Blood chemistry, hemodynamic parameters, fluid balance, plasma volume, fluid extravasation rate (FER), tissue water content and acid-base parameters were measured/calculated. Total fluid need during 120 min CPB was reduced by 60% when hypertonic saline/hydroxyethyl starch solution was added to the CPB prime (p<0.01). The reduction was related to a lowered FER. The effect was most pronounced during the first 30 min on CPB, with 0.6 (0.43) (Group H) compared with 1.5 (0.40) ml/kg/min (Group C) (p<0.01). Hemodynamics and laboratory parameters were similar in both groups. Serum concentrations of sodium and chloride increased to maximum levels of 148 (1.5) and 112 (1.6) mmol/l in Group H. To conclude: addition of 7.2% hypertonic saline and 6% poly(O-2-hydroxyethyl) starch solution to crystalloid CPB prime reduces fluid needs and FER during tepid CPB.

Key Words: fluid balance • fluid extravasation • hypothermic CPB • hypertonic saline/hydroxyethyl-starch • tepid CPB

Perfusion, Vol. 23, No. 1, 57-63 (2008)
DOI: 10.1177/0267659108094364


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