The influence of a balanced volume replacement concept on inflammation, endothelial activation, and kidney integrity in elderly cardiac surgery patients.
OBJECTIVE
A balanced fluid replacement strategy appears to be promising for correcting hypovolemia. The benefits of a balanced fluid replacement regimen were studied in elderly cardiac surgery patients.


METHODS
In a randomized clinical trial, 50 patients aged >75 years undergoing cardiac surgery received a balanced 6% HES 130/0.42 plus a balanced crystalloid solution (n = 25) or a non-balanced HES in saline plus saline solution (n = 25) to keep pulmonary capillary wedge pressure/central venous pressure between 12-14 mmHg. Acid-base status, inflammation, endothelial activation (soluble intercellular adhesion molecule-1, kidney integrity (kidney-specific proteins glutathione transferase-alpha; neutrophil gelatinase-associated lipocalin) were studied after induction of anesthesia, 5 h after surgery, 1 and 2 days thereafter. Serum creatinine (sCr) was measured approximately 60 days after discharge.


RESULTS
A total of 2,750 +/- 640 mL of balanced and 2,820 +/- 550 mL of unbalanced HES were given until the second POD. Base excess (BE) was significantly reduced in the unbalanced (from +1.21 +/- 0.3 to -4.39 +/- 1.0 mmol L(-1) 5 h after surgery; P < 0.001) and remained unchanged in the balanced group (from 1.04 +/- 0.3 to -0.81 +/- 0.3 mmol L(-1) 5 h after surgery). Evolution of the BE was significantly different. Inflammatory response and endothelial activation were significantly less pronounced in the balanced than the unbalanced group. Concentrations of kidney-specific proteins after surgery indicated less alterations of kidney integrity in the balanced than in the unbalanced group.


CONCLUSIONS
A total balanced volume replacement strategy including a balanced HES and a balanced crystalloid solution resulted in moderate beneficial effects on acid-base status, inflammation, endothelial activation, and kidney integrity compared to a conventional unbalanced volume replacement regimen.
Boldt
Joachim
J
Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany. BoldtJ@gmx.net
Suttner
Stephan
S
Brosch
Christian
C
Lehmann
Andreas
A
Röhm
Kerstin
K
Mengistu
Andinet
A
D000136:Acid-Base Equilibrium; D000368:Aged; D000369:Aged, 80 and over; D002302:Cardiac Output / Q000502:physiology; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data*; D000077324:Crystalloid Solutions; D004730:Endothelium, Vascular / Q000187:drug effects*; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D020896:Hypovolemia / Q000628:therapy*; D007249:Inflammation / Q000628:therapy*; D018799:Intercellular Adhesion Molecule-1 / Q000378:metabolism; D007552:Isotonic Solutions / Q000627:therapeutic use*; D008297:Male; D011184:Postoperative Period; D011669:Pulmonary Wedge Pressure; D051437:Renal Insufficiency / Q000517:prevention & control*; D012965:Sodium Chloride / Q000627:therapeutic use*
D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D018799:Intercellular Adhesion Molecule-1; D012965:Sodium Chloride