Volume therapy with hypertonic saline hydroxyethyl starch solution in cardiac surgery.

Area of Science:

• Cardiology
• Anesthesiology
• Critical Care Medicine

Background:

• Volume therapy in cardiac surgery is debated, with haemodynamic effects and extracorporeal oxygenation influencing choices.
• Evaluating novel fluid solutions for haemodynamic stability and efficacy is crucial in perioperative cardiac care.

Purpose of the Study:

• To compare the haemodynamic and laboratory effects of a new hypertonic saline hydroxyethyl starch solution against standard 6% hydroxyethyl starch.
• To assess the efficacy of these solutions in achieving target pulmonary capillary wedge pressure and their impact on fluid requirements.

Main Methods:

• A prospective study involving elective aortocoronary bypass grafting patients.
• Three groups: hypertonic saline hydroxyethyl starch (n=10), 6% hydroxyethyl starch (n=10), and a control group (n=10).
• Fluid administration aimed to double baseline pulmonary capillary wedge pressure; haemodynamic and laboratory variables were monitored.

Main Results:

• Significantly less hypertonic saline hydroxyethyl starch was needed to achieve target pulmonary capillary wedge pressure.
• Reduced fluid requirements were observed with hypertonic saline hydroxyethyl starch during and after cardiopulmonary bypass.
• Hypertonic saline hydroxyethyl starch group showed the greatest increase in cardiac index (+34.8%) and decrease in total systemic resistance (-29.8%).

Conclusions:

• Hypertonic saline hydroxyethyl starch demonstrates superior efficacy in volume expansion and haemodynamic support compared to standard hydroxyethyl starch in cardiac surgery.
• This solution appears to be a valuable alternative for volume therapy, improving cardiac performance without adverse effects on coagulation or organ function.