Haemodynamics and acid-base equilibrium after cardiac surgery: comparison of rapidly degradable hydroxyethyl starch solutions and albumin.
BACKGROUND
Stable haemodynamics is often achieved by administration of colloids after cardiac surgery. We conducted a prospective, randomized, open-label study comparing haemodynamics and acid-base equilibrium after infusion of two rapidly degradable hydroxyethyl starch (HES) solutions or human albumin (HA) to cardiac surgical patients.


METHODS
45 patients received a predetermined fixed dose of 15 ml kg(-1) of either 6% HES (mW 130 kDa, n = 15), 6% HES (MW 200 kDa, n = 15) or 4% HA (MW 69 kDa, n = 15) after on-pump cardiac surgery.


RESULTS
Left ventricular filling pressures assessed using pulmonary artery catheter responded similarly in all groups. mean (SD) cardiac index was higher in HES130 [3.5 l min(-1) m(-2) (0.7) ] and HES200 [3.5 l min(-1) m(-2) (0.5)] than in HA [2.8 l min(-1) m(-2) (0.6)] group after completion of infusion (P = 0.002) but no differences were detected at 2 and 18 hours. Oxygen delivery increased in both HES groups but not in HA group. After cessation of infusion base excess was the most negative in Ha group. At 2 hours mean (SD) base excess was higher in HES130 [0 (1.32)] than in HES200 [-1.32 (2.27) ] and HA [-2.3 (1.3)] group (P = 0.002, between the groups).


CONCLUSIONS
We conclude that the effect of albumin on cardiac performance is inferior than that of HES130 or HES200 in early postoperative phase after cardiac surgery. HES130 induces no alterations in acid-base equilibrium whereas a negative base excess was observed after HA infusion.
Niemi
T
T
Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital, Meilahti Hospital, Helsinki, Finland. tomi.niemi@hus.fi
Schramko
A
A
Kuitunen
A
A
Kukkonen
S
S
Suojaranta-Ylinen
R
R
D000136:Acid-Base Equilibrium / Q000502:physiology*; D000328:Adult; D000368:Aged; D000418:Albumins / Q000008:administration & dosage*; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000008:administration & dosage; D011182:Postoperative Care / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome
D000418:Albumins; D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes