open access

Vol 50, No 2 (2018)
Original and clinical articles
Published online: 2018-06-26
Submitted: 2017-08-17
Accepted: 2018-05-25
Get Citation

Hypertonic saline-hydroxyethyl starch solution attenuates fluid accumulation in cardiac surgery patients: a randomized controlled double-blind trial

Kati Järvelä, Markku Rantanen, Tiit Kööbi, Heini Huhtala, Tero Sisto
DOI: 10.5603/AIT.2018.0019
·
Pubmed: 29953575
·
Anaesthesiol Intensive Ther 2018;50(2):122-127.

open access

Vol 50, No 2 (2018)
Original and clinical articles
Published online: 2018-06-26
Submitted: 2017-08-17
Accepted: 2018-05-25

Abstract

Background: Significant fluid retention is common after cardiac surgery with the use of cardiopulmonary bypass (CPB). The aim of the study was to evaluate the effects of hypertonic saline-hydroxyethyl starch (HS-HES) solution on fluid accumulation in patients undergoing coronary artery bypass grafting surgery (CABG). Methods: Fifty adult male patients undergoing coronary bypass surgery were enrolled in this interventional, randomized, double-blinded study to compare HS-HES with saline solution. The study fluid (250 mL) was given into the venous reservoir of the CPB circuit at the time of aortic declamping. Results: Body mass change from the baseline to the first postoperative morning was significantly less in the HS-HES group compared with the control group (3.3 ± 1.5 kg vs. 4.4 ± 1.5 kg, P = 0.022). In the extracellular water (ECW) or ECW-balance, there were no significant differences between the groups. The need for fluids and diuretic medication did not differ between the groups during the perioperative period. Conclusions: Our study shows that 250 mL of HS-HES solution can reduce perioperative fluid accumulation to some degree in patients undergoing CABG surgery with CPB.

Abstract

Background: Significant fluid retention is common after cardiac surgery with the use of cardiopulmonary bypass (CPB). The aim of the study was to evaluate the effects of hypertonic saline-hydroxyethyl starch (HS-HES) solution on fluid accumulation in patients undergoing coronary artery bypass grafting surgery (CABG). Methods: Fifty adult male patients undergoing coronary bypass surgery were enrolled in this interventional, randomized, double-blinded study to compare HS-HES with saline solution. The study fluid (250 mL) was given into the venous reservoir of the CPB circuit at the time of aortic declamping. Results: Body mass change from the baseline to the first postoperative morning was significantly less in the HS-HES group compared with the control group (3.3 ± 1.5 kg vs. 4.4 ± 1.5 kg, P = 0.022). In the extracellular water (ECW) or ECW-balance, there were no significant differences between the groups. The need for fluids and diuretic medication did not differ between the groups during the perioperative period. Conclusions: Our study shows that 250 mL of HS-HES solution can reduce perioperative fluid accumulation to some degree in patients undergoing CABG surgery with CPB.

Get Citation

Keywords

saline solution, hypertonic; coronary artery bypass; cardiopulmonary bypass; water

About this article
Title

Hypertonic saline-hydroxyethyl starch solution attenuates fluid accumulation in cardiac surgery patients: a randomized controlled double-blind trial

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 50, No 2 (2018)

Pages

122-127

Published online

2018-06-26

DOI

10.5603/AIT.2018.0019

Pubmed

29953575

Bibliographic record

Anaesthesiol Intensive Ther 2018;50(2):122-127.

Keywords

saline solution
hypertonic
coronary artery bypass
cardiopulmonary bypass
water

Authors

Kati Järvelä
Markku Rantanen
Tiit Kööbi
Heini Huhtala
Tero Sisto

References (19)
  1. Reitsma S, Slaaf DW, Vink H, et al. The endothelial glycocalyx: composition, functions, and visualization. Pflugers Arch. 2007; 454(3): 345–359.
  2. Bruegger D, Rehm M, Abicht J, et al. Shedding of the endothelial glycocalyx during cardiac surgery: on-pump versus off-pump coronary artery bypass graft surgery. J Thorac Cardiovasc Surg. 2009; 138(6): 1445–1447.
  3. Toraman F, Evrenkaya S, Yuce M, et al. Highly positive intraoperative fluid balance during cardiac surgery is associated with adverse outcome. Perfusion. 2004; 19(2): 85–91.
  4. Mazzoni MC, Borgström P, Arfors KE, et al. Dynamic fluid redistribution in hyperosmotic resuscitation of hypovolemic hemorrhage. Am J Physiol. 1988; 255(3 Pt 2): H629–H637.
  5. Fujita T, Matsuda Y, Shibamoto T, et al. Effect of hypertonic saline infusion on renal vascular resistance in anesthetized dogs. Jpn J Physiol. 1991; 41(4): 653–663.
  6. Sirvinskas E, Sneider E, Svagzdiene M, et al. Hypertonic hydroxyethyl starch solution for hypovolaemia correction following heart surgery. Perfusion. 2007; 22(2): 121–127.
  7. Tahvanainen A, Leskinen M, Koskela J, et al. Whole-body impedance cardiography in the measurement of cardiac output. Crit Care Med. 1997; 25(5): 779–785.
  8. Järvelä K, Kaukinen S. Hypertonic saline (7.5%) decreases perioperative weight gain following cardiac surgery. J Cardiothorac Vasc Anesth. 2002; 16(1): 43–46.
  9. Kvalheim VL, Farstad M, Steien E, et al. Infusion of hypertonic saline/starch during cardiopulmonary bypass reduces fluid overload and may impact cardiac function. Acta Anaesthesiol Scand. 2010; 54(4): 485–493.
  10. Parrinello G, Di Pasquale P, Torres D, et al. Troponin I release after intravenous treatment with high furosemide doses plus hypertonic saline solution in decompensated heart failure trial (Tra-HSS-Fur). Am Heart J. 2012; 164(3): 351–357.
  11. Reinhart K, Perner A, Sprung CL, et al. European Society of Intensive Care Medicine. Consensus statement of the ESICM task force on colloid volume therapy in critically ill patients. Intensive Care Med. 2012; 38(3): 368–383.
  12. van Haren FMP, Sleigh J, Boerma EC, et al. Hypertonic fluid administration in patients with septic shock: a prospective randomized controlled pilot study. Shock. 2012; 37(3): 268–275.
  13. Badiwala MV, Ramzy D, Tumiati LC, et al. Donor pretreatment with hypertonic saline attenuates primary allograft dysfunction: a pilot study in a porcine model. Circulation. 2009; 120(11 Suppl): S206–S214.
  14. Kolsen-Petersen JA, Nielsen JOD, Tonnesen E. Acid base and electrolyte changes after hypertonic saline (7.5%) infusion: a randomized controlled clinical trial. Scand J Clin Lab Invest. 2005; 65(1): 13–22.
  15. Goy-Thollot I, Garnier F, Bonnet JM. The effects of 10% hypertonic saline, 0.9% saline and hydroxy ethyl starch infusions on hydro-electrolyte status and adrenal function in healthy conscious dogs. Res Vet Sci. 2007; 83(3): 322–330.
  16. Harada K, Franklin A, Johnson RG, et al. Acidemia and hypernatremia enhance postischemic recovery of excitation-contraction coupling. Circ Res. 1994; 74(6): 1197–1209.
  17. Bakker RC, Osse RJ, Tulen JHM, et al. Preoperative and operative predictors of delirium after cardiac surgery in elderly patients. Eur J Cardiothorac Surg. 2012; 41(3): 544–549.
  18. Roquilly A, Mahe PJ, Latte DD, et al. Continuous controlled-infusion of hypertonic saline solution in traumatic brain-injured patients: a 9-year retrospective study. Crit Care. 2011; 15(5): R260.
  19. Kvalheim VL, Rynning SE, Farstad M, et al. Fluid overload during cardiopulmonary bypass is effectively reduced by a continuous infusion of hypertonic saline/dextran (HSD). Scand Cardiovasc J. 2008; 42(1): 63–70.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

VM Media sp. z o.o. VM Group sp.k., Grupa Via Medica, Świętokrzyska 73 St., 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl