title: Distribution of normal saline and 5% albumin infusions in cardiac surgical patients.
abstract: OBJECTIVE
  To determine the relative distribution of fluid within the extracellular fluid volume (ECFV) and the effect on oxygen delivery after infusing either normal saline or 5% albumin in cardiac surgical patients.
  
  
  METHODS
  Prospective, randomized, unblinded, interventional study.
  
  
  METHODS
  Cardiac surgical intensive care unit in a 450-bed teaching hospital.
  
  
  METHODS
  Postoperative cardiac surgical patients (n = 40).
  
  
  METHODS
  Infusion of either normal saline or 5% albumin to a hemodynamic end point determined by the patient's clinician.
  
  
  RESULTS
  Plasma volume (PV), ECFV, cardiac index, and arterial oxygen content were measured immediately before (baseline) and after each fluid infusion. PV and ECFV were measured by dilution of (131)I-albumin and [(35)S]sodium sulfate, respectively. Interstitial fluid volume (ISFV) was calculated as ECFV - PV. Baseline values for PV, ISFV, ECFV, and oxygen delivery index did not differ between treatment groups. Infusion of normal saline and 5% albumin increased PV by 9 +/- 23% and 52 +/- 84% of the volume infused, respectively (p <.05), whereas there was no significant difference between saline and albumin in the change in ISFV per volume infused. Only 5% albumin significantly increased cardiac index, although oxygen delivery did not change significantly after either infusion.
  
  
  CONCLUSIONS
  In postoperative cardiac surgical patients, infusion of 5% albumin is approximately five times as efficient as a PV expander but has comparable effects on changes in ISFV and oxygen delivery relative to normal saline.
authors.affiliation: Program in Critical Care Medicine, Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada. ernest@sub.net.au
authors.forename: D
authors.initials: D
authors.lastname: Ernest
authors.forename: A S
authors.initials: AS
authors.lastname: Belzberg
authors.forename: P M
authors.initials: PM
authors.lastname: Dodek
mesh_terms: D002315:Cardiopulmonary Bypass; D003102:Colloids / Q000493:pharmacokinetics; D005110:Extracellular Space / Q000378:metabolism; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D010953:Plasma Volume; D011182:Postoperative Care; D011446:Prospective Studies; D012709:Serum Albumin / Q000493:pharmacokinetics*; D012965:Sodium Chloride / Q000493:pharmacokinetics*
chemical_list: D003102:Colloids; D012709:Serum Albumin; D012965:Sodium Chloride