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Volume therapy with a new hydroxyethyl starch solution in cardiac surgical patients before cardiopulmonary bypass
Joachim Boldt1, Andreas Lehmann, Reni Römpert
1Department of Anesthesiology and Intensive Care Medicine, and Clinic of Cardiac Surgery, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany.
Objective:
To compare the hemodynamic efficacy of a new hydroxyethyl starch (HES) preparation (130/0.4) with an HES 200/0.5 solution.
Design:
Prospective, randomized, double-blind, phase II study.
Setting:
An urban, university-affiliated hospital.
Participants:
Twenty patients undergoing elective first-time cardiac surgery.
Interventions:
After induction of anesthesia and before the start of surgery, a new HES 130/0.4 (molecular weight, 130,000 d; degree of substitution, 0.4) (n = 10) or HES 200/0.5 (molecular weight, 200,000 d; degree of substitution, 0.5) (n = 10) was infused (10 mL/kg) within 30 minutes when pulmonary capillary wedge pressure was less than 10 mmHg.
Measurements And Main Results:
Extensive hemodynamic monitoring was performed 30 and 60 minutes after the end of infusion. Then surgery was started. Standard laboratory parameters were measured before surgery and on the 1st postoperative day. A similar amount of HES was given in both groups (HES 130, 795+/-75 mL; HES 200, 820+/-90 mL). Filling pressures (central venous pressure, pulmonary capillary wedge pressure) and cardiac index increased similarly in both groups and remained significantly elevated 60 minutes after the end of infusion. All other hemodynamic parameters were similar between the two volume groups. Renal (creatinine) and hepatic function (aspartate aminotransferase, alanine aminotransferase) and hemostasis (platelet count, activated partial thromboplastin time, blood loss) were without group differences until the morning of the 1st postoperative day.
Conclusions:
The new 6% HES 130/0.4 was as effective as a 6% HES 200/0.5 preparation in regard to hemodynamic efficacy. No negative side effects on organ function were seen. The 6% HES 130/0.4 solution may become an alternative strategy for volume therapy in cardiac surgery.