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Cardiorespiratory responses to hypertonic saline solution in cardiac operations.
J Boldt1, B Zickmann, M Ballesteros
1Department of Anesthesiology, Justus-Liebig-University, Giessen, Germany.
The Annals of Thoracic Surgery
|April 1, 1991
Summary
Hypertonic saline-hydroxyethylstarch (HS-HES) solution effectively improved hemodynamics and oxygen delivery in patients undergoing cardiopulmonary bypass, requiring smaller volumes than HES alone. This enhanced fluid balance and pulmonary gas exchange post-surgery.
Area of Science:
- Cardiology
- Anesthesiology
- Critical Care Medicine
Background:
- Impaired perfusion in patients can benefit from hypertonic saline (HS) solutions.
- Cardiopulmonary bypass (CPB) presents significant cardiorespiratory challenges.
Purpose of the Study:
- To investigate the cardiorespiratory response to a 7.2% NaCl in hydroxyethylstarch (HES) solution (HS-HES) versus 6% HES in patients undergoing prolonged CPB.
Main Methods:
- Prospective study comparing HS-HES group (n=15) with a HES-only control group (n=15).
- Infusion aimed to double pulmonary artery occlusion pressure preoperatively.
- Hemodynamics, oxygen transport, and gas exchange were monitored before and after infusion, and before/after CPB.
Main Results:
- Significantly less HS-HES volume (3.06 mL/kg) was needed compared to HES (10.3 mL/kg) to achieve target pulmonary artery occlusion pressure.
- HS-HES group maintained negative fluid balance during and after CPB.
- HS-HES demonstrated superior increases in cardiac index (+40%) and oxygen delivery, with least compromised pulmonary gas exchange post-CPB.
Conclusions:
- HS-HES solution is a more effective and volume-sparing resuscitation fluid for patients undergoing prolonged CPB.
- HS-HES improves hemodynamic response and oxygen transport while mitigating pulmonary complications.
- This approach offers significant advantages in fluid management and cardiorespiratory support during CPB.