title: The effect of volume replacement on serum protein concentration during cardiopulmonary bypass.
abstract: Although controversy exists concerning the optimal total protein and colloid osmotic pressure that should be maintained during cardiopulmonary bypass (CPB), the primary volume expanders remain albumin and 6% hetastarch. The purpose of this study was to quantify the effect of adding boluses of volume replacement agents under various conditions to total serum protein values during CPB. A standard CPB circuit was utilized in eight 45-kg swine that had a priming volume (physiologic saline solution) of 2309 +/- 245 mL. Volumetric alterations occurred throughout the CPB period by the addition of combinations of physiologic saline solution, 6% hetastarch or 5% swine albumin. Pre- and postadministration samples were assayed for total serum protein, total protein, and albumin throughout the CPB period and at pre- and postvolume administration times. There was a significant decline in total serum protein with the initiation of CPB (6.14 +/- 0.49 g/dL vs. 3.40 +/- 0.43 g/dL, p < .0001). Addition of 12.5 g of swine albumin (N = 5) to two different swine increased total serum protein significantly when compared to adding 500 mL of 6% hetastarch (N = 6) (swine albumin 12.4 +/- 6.3% vs. hetastarch 3.3 +/- 2.1%, p < .005). A reduction in total serum protein occurred after hemodilution with varying amount of physiologic saline solution: 250-450 mL (7.4 +/- 4.5%), 451-650 mL (9.6 +/- 5.6%), and 651-1050 mL (19.4 +/- 4.0%). In summary, knowledge of total serum protein concentration and estimated circulating blood volume can be used to guide albumin and hetastarch administration following hemodilution.
authors.affiliation: Division of Clinical Perfusion Education, University of Nebraska Medical Center, School of Allied Health Professionals, Omaha, USA. skmiecik@smdc.org
authors.forename: S A
authors.initials: SA
authors.lastname: Kmiecik
authors.forename: A H
authors.initials: AH
authors.lastname: Stammers
authors.forename: C M
authors.initials: CM
authors.lastname: Petterson
authors.forename: J L
authors.initials: JL
authors.lastname: Liu
authors.forename: J D
authors.initials: JD
authors.lastname: Nichols
authors.forename: R J
authors.initials: RJ
authors.lastname: Kohtz
authors.forename: N J
authors.initials: NJ
authors.lastname: Mills
authors.forename: H
authors.initials: H
authors.lastname: Zheng
authors.forename: L M
authors.initials: LM
authors.lastname: Hock
mesh_terms: D000418:Albumins / Q000008:administration & dosage; D000818:Animals; D001798:Blood Proteins / Q000032:analysis*; D001810:Blood Volume; D002315:Cardiopulmonary Bypass; D006438:Hemodilution; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage; D012044:Regression Analysis; D013552:Swine
chemical_list: D000418:Albumins; D001798:Blood Proteins; D006895:Hydroxyethyl Starch Derivatives