Fluid overload during cardiopulmonary bypass is effectively reduced by a continuous infusion of hypertonic saline/dextran (HSD).
OBJECTIVE
Cardiopulmonary bypass (CPB) is associated with fluid overload. We examined how a continuous infusion of hypertonic saline/dextran (HSD) influenced fluid shifts during CPB.


METHODS
Fourteen animals were randomized to a control-group (CT-group) or a hypertonic saline/dextran-group (HSD-group). Ringer's solution was used as CPB-prime and as maintenance fluid at a rate of 5 ml/kg/h. In the HSD group, 1 ml/kg/h of the maintenance fluid was substituted with HSD. After 60 min of normothermic CPB, hypothermic CPB was initiated and continued for 90 min. Fluid was added to the CPB-circuit as needed to maintain a constant level in the venous reservoir. Fluid balance, plasma volume, total tissue water (TTW), intracranial pressure (ICP) and fluid extravasation rates (FER) were measured/calculated.


RESULTS
In the HSD-group the fluid need was reduced with 60% during CPB compared with the CT-group. FER was 0.38(0.06) ml/kg/min in the HSD-group and 0.74 (0.16) ml/kg/min in the CT-group. TTW was significantly lower in the heart and some of the visceral organs in the HSD-group. In this group ICP remained stable during CPB, whereas an increase was observed in the CT-group (p<0.01).


CONCLUSIONS
A continuous infusion of HSD reduced the fluid extravasation rate and total fluid gain during CPB. TTW was reduced in the heart and some visceral organs. During CPB ICP remained normal in the HSD-group, whereas an increase was present in the CT-group. No adverse effects were observed.
Kvalheim
Venny L
VL
Department for Heart Disease, University of Bergen, Haukeland University Hospital, Bergen, Norway.
Rynning
Stein E
SE
Farstad
Marit
M
Haugen
Oddbjørn
O
Nygreen
Else
E
Mongstad
Arve
A
Husby
Paul
P
D000818:Animals; D001834:Body Water / Q000378:metabolism; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002560:Cerebrovascular Circulation / Q000187:drug effects; D003911:Dextrans / Q000008:administration & dosage*; D004487:Edema / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology / Q000517:prevention & control*; D018495:Fluid Shifts / Q000187:drug effects*; D006439:Hemodynamics / Q000187:drug effects; D007262:Infusions, Intravenous; D007427:Intracranial Pressure / Q000187:drug effects; D023421:Models, Animal; D009997:Osmotic Pressure; D010953:Plasma Volume / Q000187:drug effects; D012965:Sodium Chloride / Q000008:administration & dosage*; D013552:Swine; D013997:Time Factors; D014882:Water-Electrolyte Balance / Q000187:drug effects*; D014883:Water-Electrolyte Imbalance / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology / Q000517:prevention & control*
D003911:Dextrans; C104375:hypertonic saline-dextran solution; D012965:Sodium Chloride