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.
Boldt
Joachim
J
Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany. BoldtJ@gmx.net
Mayer
Jochen
J
Brosch
Christian
C
Lehmann
Andreas
A
Mengistu
Andinet
A
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