Intra- and extravascular volume status in patients undergoing mitral valve replacement: crystalloid vs. colloid priming of cardiopulmonary bypass.
OBJECTIVE
Cardiopulmonary bypass is associated with changes of intra- and extravascular volume status often resulting in cardiopulmonary dysfunction. The purpose of this prospective double-blind study was to evaluate the influence of different priming solutions of the extracorporeal circuit on intra- and extravascular volume status and haemodynamics in patients undergoing elective mitral valve replacement.


METHODS
Twenty-two patients with mitral valve insufficiency were randomly allocated into two equal groups. In Group 1 cardiopulmonary bypass was primed with a nearly isooncotic solution consisting of 4% albumin. The second group received a pure crystalloid priming solution. The thermo-dye indicator dilution technique was used for the assessment of cardiac output, central and pulmonary blood volume, right ventricular end-diastolic volume and total blood volume.


RESULTS
Patients in the crystalloid group showed increased intraoperative fluid requirements. Significantly more fluid was accumulated in the extravascular space whereas total blood volume was decreased after surgery. Stroke volume index (SVI) was significantly decreased in the immediate postoperative period when compared to baseline. As indicated by the increase in extravascular fluid content after surgery, both colloid and crystalloid priming volumes were transferred to the extravascular space.


CONCLUSIONS
The use of colloid priming solutions in patients with mitral valve insufficiency leads to less fluid requirements and significantly reduced fluid shift in the interstitium. However, these changes are not associated with changes in haemodynamic parameters or short term outcome.
Rex
S
S
Klinik für Anästhesiologie, Universitätsklinikum der RWTH Aachen, Germany.
Scholz
M
M
Weyland
A
A
Busch
T
T
Schorn
B
B
Buhre
W
W
D000318:Adrenergic beta-Agonists; D000368:Aged; D000465:Algorithms; D000758:Anesthesia; D001810:Blood Volume / Q000502:physiology; D002315:Cardiopulmonary Bypass; D003102:Colloids; D000077324:Crystalloid Solutions; D004280:Dobutamine; D004311:Double-Blind Method; D005110:Extracellular Space / Q000502:physiology*; D005260:Female; D006334:Heart Function Tests; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007552:Isotonic Solutions; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D011292:Premedication
D000318:Adrenergic beta-Agonists; D003102:Colloids; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D004280:Dobutamine