Prospective observational study for perioperative volume replacement with 6% HES 130/0,42, 4% gelatin and 6% HES 200/0,5 in cardiac surgery.
BACKGROUND
the constantly growing amount of different kinds of colloid fluids necessitates comparative investigations with regards to the safety and effectivity in clinical use of these preparations. Hence we compared three colloid fluids in an observational study. The objective was the exploration of the influence of these three colloids on blood coagulation, hemodynamics and renal function of the cardiac surgical patient.


METHODS
we included 90 patients undergoing an elective open-heart surgery with the use of the heart-lung machine and observed them consecutively. Group 1 [gelatin 4% (n = 30)], Group 2 [HES 200/0,5 (n = 30)] and Group 3 [HES 130/0,42 (n = 30)]. We measured the perioperative volume replacement, the administration of blood- and coagulation-products, the application of catecholamines, the renal function, blood gas and the platelet aggregation using multiplate electrode analyzer (Multiplate, Dynabyte medical, Munich, Germany).


RESULTS
the gelatin-group needed significantly more norepinephrine than the HES 130/0.42 group. The responsible surgeon considered the blood coagulation in the HES 200/0.5 group most frequently as impaired. Furthermore we saw a significant decrease in platelet function in the HES 200/0.5 group when performing the multiplate-analysis (ADP-and COL-test). HES 130/0.4 as well as gelatin 4% showed no significant change in platelet function. The gelatin-group and the HES 200/0.5 needed significantly more aprotinine than the HES 130/0.4 group. We saw no significant difference with regards to administration of blood and coagulation products between the three groups. The urinary excretion during the intervention was significantly higher in the HES 200/0.5 group and in the gelatin group than in the HES 130/0.4 group.


CONCLUSIONS
our results confirm the lower stabilizing effect of gelatin on circulation during fluid resuscitation. The blood coagulation was mostly impaired due to HES 200/0.5 confirmed by the multiplate®-analysis as well as by different clinical findings.
University of Düsseldorf, Department of Anaesthesiology, Moorenstr.5, 40225 Düsseldorf, Germany. Michael.Winterhalter@med.uni-duesseldorf.de
Michael
M
Winterhalter
P
P
Malinski
O
O
Danzeisen
S
S
Sixt
E
E
Monaca
T
T
Jüttner
M
M
Peiper
P
P
Kienbaum
A
A
Koester
N
N
Rahe-Meyer
D000368:Aged; D000369:Aged, 80 and over; D001777:Blood Coagulation / Q000187:drug effects; D001810:Blood Volume / Q000187:drug effects; D001835:Body Weight; D006348:Cardiac Surgical Procedures; D005260:Female; D005780:Gelatin / Q000627:therapeutic use*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use*; D007668:Kidney / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010642:Phenoxyacetates / Q000627:therapeutic use*; D010952:Plasma Substitutes / Q000627:therapeutic use; D011446:Prospective Studies
C485123:HES 130-0.4; D006895:Hydroxyethyl Starch Derivatives; D010642:Phenoxyacetates; D010952:Plasma Substitutes; C022160:refortan; D005780:Gelatin