Volume replacement with a balanced hydroxyethyl starch (HES) preparation in cardiac surgery patients.
OBJECTIVE
Balanced fluids appear to be have advantages over unbalanced fluids for correcting hypovolemia. The effects of a new balanced hydroxyethyl starch (HES) were studied in cardiac surgery patients.


METHODS
Prospective, randomized, unblinded study.


METHODS
Clinical study in a single cardiac surgery institution.


METHODS
Sixty patients undergoing elective cardiac surgery with cardiopulmonary bypass.


METHODS
Patients received either a balanced 6% HES 130/0.4 plus a balanced crystalloid (n = 30) or an unbalanced HES-in-saline plus saline (n = 30) to keep cardiac index >2.5 L/min/m(2).


RESULTS
Base excess (BE), kidney function, inflammatory response (interleukins-6, -10), endothelial activation (intercellular adhesion molecule-1 [ICAM]), and coagulation (thromboelastometry, whole blood aggregation) were measured after induction of anesthesia, after surgery and 5 hours later, and at the 1st and 2nd postoperative days; 2,950 +/- 530 mL of balanced and 3,050 +/- 560 mL of unbalanced HES were given. BE was reduced significantly in the unbalanced group (from 1.11 +/- 0.71 mmol/L to -5.11 +/- 0.48 mmol/L after surgery) and remained unchanged in the balanced group. Balanced volume replacement resulted in significantly lower IL-6, IL-10, and ICAM plasma concentrations and lower urine concentrations of kidney-specific proteins than in the unbalanced group. After surgery, thromboelastometry data and platelet function were changed significantly in both groups; 5 hours thereafter they were significantly changed only in the unbalanced group.


CONCLUSIONS
A plasma-adapted HES preparation in addition to a balanced crystalloid resulted in significantly less decline in BE, less increase in concentrations of kidney-specific proteins, less inflammatory response and endothelial damage, and fewer changes in hemostasis compared with an unbalanced fluid strategy.
Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany. BoldtJ@gmx.net
Joachim
J
Boldt
Jochen
J
Mayer
Christian
C
Brosch
Andreas
A
Lehmann
Andinet
A
Mengistu
D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia; D016063:Blood Loss, Surgical; D001810:Blood Volume / Q000187:drug effects*; D006348:Cardiac Surgical Procedures / Q000401:mortality; D002315:Cardiopulmonary Bypass; D002395:Catecholamines / Q000627:therapeutic use; D003422:Critical Care; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006439:Hemodynamics / Q000187:drug effects; D006487:Hemostasis / Q000187:drug effects; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000737:chemistry / Q000627:therapeutic use*; D007249:Inflammation / Q000453:epidemiology / Q000209:etiology; D007668:Kidney / Q000187:drug effects / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000737:chemistry / Q000627:therapeutic use*; D010979:Platelet Function Tests; D017582:Renal Replacement Therapy; D013916:Thrombelastography; D014882:Water-Electrolyte Balance / Q000187:drug effects
D002395:Catecholamines; D004232:Diuretics; D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes