[Individualized hemodilution in acute brain infarct using a 20% albumin solution and physiological saline solution].
OBJECTIVE
To determine the effect of normovolaemic haemodilution in patients after a cerebrovascular accident.


METHODS
Prospective, randomized clinical trial.


METHODS
St Lucas Hospital, Amsterdam.


METHODS
Normovolaemic haemodilution was achieved by means of bloodletting and administration of a 20% solution of albumin plus crystalline infusion fluids under haemodynamic and rheological monitoring during the acute phase of the cerebral infarction. All patients were subjected to general intensive care and monitoring with a pulmonary artery catheter. This custom-tailored fluid therapy was guided by a pulmonary wedge pressure of 12 mm Hg (SD 3) and a haematocrit (Ht) of 0.32 l/l (SD 0.02). The control group only received individually dosed rehydration with crystalline infusion fluids. Endpoints of the study after 3 months were mortality and dependence/independence concerning everyday functioning.


RESULTS
The results in the total haemodilution group and the control group did not differ significantly. However, in the subgroup with normal Ht (< 0.45 l/l; n = 201) there was a significant reduction (p < 0.05) of the mortality after 3 months (27% and 16%, respectively) and an increase of independence at home (35% and 48%, respectively) due to a reduction of the viscosity by means of haemodilution with albumin (a specific viscosity effect in the normovolaemic group). In the control group with raised Ht (dehydration; Ht > or = 0.45 l/l; n = 50) there was a significant decrease (p < 0.005) of the mortality after 3 months (27% and 8%, respectively) and an increase of independence at home (35% and 59%, respectively) compared with the control group with normal Ht without signs of dehydration (Ht < 0.045 l/l; n = 102), due to rehydration exclusively with crystalline infusion fluids (a specific rehydration effect in the dehydrated group).


CONCLUSIONS
In cerebrovascular accident patients haemodilution should be adjusted individually; in normovolaemic patients haemodilution should be carried out with an albumin solution; the higher the Ht, the more rehydration with crystalline infusion fluids is to be carried out.
Goslinga
H
H
Sint Lucas Ziekenhuis, afd. Anesthesiologie en Intensive Care, Amsterdam.
Eijzenbach
V
V
Heuvelmans
J H
JH
van de Nes
J C
JC
Kurk
R M
RM
Bezemer
P D
PD
D000203:Activities of Daily Living; D000368:Aged; D001809:Blood Viscosity; D002544:Cerebral Infarction / Q000097:blood / Q000628:therapy*; D006400:Hematocrit; D006438:Hemodilution / Q000379:methods*; D006801:Humans; D007552:Isotonic Solutions; D011446:Prospective Studies; D012709:Serum Albumin / Q000008:administration & dosage; D012965:Sodium Chloride / Q000008:administration & dosage
D007552:Isotonic Solutions; D012709:Serum Albumin; D012965:Sodium Chloride
Hemodilutie op maat bij het acute herseninfarct met behulp van een 20%-albumine-oplossing en fysiologische zoutoplossing.