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[Colloidal hypertonic solutions in cardiac surgery]

J Boldt1, H Hammermann, G Hempelmann

  • 1Abteilung Anästhesiologie und Operative Intensivmedizin, Justus-Liebig-Universität Giessen.

Zentralblatt Fur Chirurgie
|January 1, 1993
PubMed
Summary
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Hypertonic saline-hydroxyethyl starch (HS-HES) solution effectively improved hemodynamics and reduced fluid needs in cardiac surgery patients undergoing cardiopulmonary bypass (CPB). This hypertonic solution enhanced cardiac index and improved microcirculation while minimizing pulmonary complications.

Area of Science:

  • Cardiology
  • Anesthesiology
  • Critical Care Medicine

Context:

  • Volume therapy in cardiac surgery remains debated, with hemodynamic efficacy and cardiopulmonary bypass (CPB) influence being critical.
  • Hypertonic sodium (HS) solutions, effective in hemorrhagic shock, are explored for cardiac surgery patients.
  • Aortocoronary bypass grafting patients were studied to evaluate HS-HES efficacy.

Purpose:

  • To assess the efficacy of hypertonic saline-hydroxyethyl starch (HS-HES) solution in cardiac surgery patients.
  • To compare HS-HES with standard 6% hydroxyethyl starch (HES) solution for volume replacement during CPB.
  • To evaluate the impact of HS-HES on hemodynamic parameters, fluid requirements, and pulmonary function.

Summary:

  • Infusion of HS-HES (7.5% saline in 6% HES) effectively doubled pulmonary capillary wedge pressure (PCWP) using less volume than standard 6% HES.

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  • HS-HES administration resulted in increased cardiac index (CI) and decreased systemic vascular resistance (SVR) compared to HES.
  • Patients receiving preoperative HS-HES required less fluid during CPB, showed improved pulmonary function (paO2, Qs/Qt), and enhanced skin capillary microcirculation.

    • Impact:

    • HS-HES offers improved hemodynamic management and reduced fluid overload in cardiac surgery patients.
    • Preoperative HS-HES infusion significantly enhances microcirculation, potentially improving tissue perfusion.
    • This study suggests HS-HES as a beneficial alternative for volume therapy in CPB patients, optimizing fluid management and patient outcomes.