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RETRACTED: Volume loading with hypertonic saline solution: endocrinologic and circulatory responses

J Boldt1, C Knothe1, B Zickmann1

  • 1From the Department of Anesthesiology and Intensive Care Medicine, Department of Cardiovascular Surgery, Justus-Liebig-University Giessen, Giessen, Germany.

Journal of Cardiothoracic and Vascular Anesthesia
|June 1, 1994
PubMed
Summary

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Hypertonic saline-hydroxyethyl starch (HS-HES) effectively expands volume and improves cardiac index (CI) during cardiac surgery. HS-HES and low molecular weight HES (LMW-HES) increased atrial natriuretic peptide (ANP) levels, while HS-HES showed a greater CI increase.

Area of Science:

  • Cardiology
  • Anesthesiology
  • Critical Care Medicine

Background:

  • Volume expansion is crucial in cardiac surgery.
  • Hypertonic saline solutions offer potential for effective volume loading.
  • Hydroxyethyl starch (HES) solutions are commonly used for fluid resuscitation.

Purpose of the Study:

  • To compare the effects of hypertonic saline-hydroxyethyl starch (HS-HES) versus low molecular weight HES (LMW-HES) on circulatory and endocrinologic responses during aorto-coronary bypass grafting.
  • To evaluate the impact of these fluid strategies on cardiac index (CI) and hormonal levels.

Main Methods:

  • A randomized controlled trial involving 45 patients undergoing elective aorto-coronary bypass grafting.
  • Patients received either HS-HES or LMW-HES for volume loading to double pulmonary capillary wedge pressure (PCWP).

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  • Plasma levels of atrial natriuretic peptide (ANP), endothelin, vasopressin, and catecholamines were measured, along with systemic circulation and capillary skin blood flow.

    • Main Results:

    • Both HS-HES and LMW-HES increased ANP levels, while the control group showed a decrease.
    • HS-HES infusion led to a significant increase in plasma endothelin levels.
    • Cardiac index (CI) increased most significantly with HS-HES (+65%), remaining higher post-bypass compared to controls.

    Conclusions:

    • Hypertonic saline-hydroxyethyl starch is an effective volume expander, improving cardiac index during cardiac surgery.
    • Both HS-HES and LMW-HES influence hormonal responses, with HS-HES demonstrating a more pronounced positive effect on CI.
    • These findings support the use of HS-HES for fluid management in patients undergoing major cardiovascular procedures.