title: Fluid therapy using a balanced crystalloid solution and acid-base stability after cardiac surgery.
abstract: OBJECTIVE
  To evaluate the effect of fluid therapy using Accusol (Baxter Healthcare, McGaw Park, Ill, USA), a crystalloid solution containing sodium bicarbonate and other electrolytes and having a strong ion difference of 35 mEq/L, on acid-base stability after cardiac surgery.
  
  
  METHODS
  Retrospective per-protocol comparison.
  
  
  METHODS
  Intensive care unit of St Vincent's Hospital, a teaching hospital in Melbourne, Australia.
  
  
  METHODS
  Consecutive adult patients admitted in daytime hours after elective on-pump coronary artery bypass graft surgery between May and October 2008 constituted the "pre-Accusol group" (n=40), and those admitted between May and October 2009 and who were treated with Accusol constituted the "Accusol group" (n=51).
  
  
  METHODS
  The fluids and their component electrolytes administered; change in standard base excess (SBE) between the time of intensive care admission and 04:00 h the next day.
  
  
  RESULTS
  The Accusol group received a median Accusol dose of 1.86 mL/kg/h (interquartile range, 1.51-2.20 mL/ kg/h), which accounted for 38% (SD, 10%) of the total volume of fluid administered. The change in SBE was +0.03mmol/L (95% CI, -0.57 to 0.64 mmol/L; P = 0.91) in the Accusol group compared with -2.05mmol/L (95% CI, -2.64 to -1.45; P < 0.01) in the pre-Accusol group. The strong ion difference of the electrolytes administered as components of fluid therapies was higher in the Accusol group by 55.5mEq (95% CI, 40.0 to 71.0mEq; P < 0.01). Only 8% of the Accusol group received albumin compared with 48% of the pre-Accusol group (P < 0.01).
  
  
  CONCLUSIONS
  SBE was more stable in patients treated with Accusol. Further studies are needed to determine whether use of solutions such as Accusol influences important patient outcomes.
authors.affiliation: Intensive Care, St Vincent's Hospital, Melbourne, VIC. roger.smith@svhm.org.au
authors.forename: Roger J
authors.initials: RJ
authors.lastname: Smith
authors.forename: David A
authors.initials: DA
authors.lastname: Reid
authors.forename: Elizabeth F
authors.initials: EF
authors.lastname: Delaney
authors.forename: John D
authors.initials: JD
authors.lastname: Santamaria
mesh_terms: D000136:Acid-Base Equilibrium / Q000187:drug effects*; D000328:Adult; D000368:Aged; D002985:Clinical Protocols; D015331:Cohort Studies; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000378:metabolism* / Q000628:therapy; D003422:Critical Care; D000077324:Crystalloid Solutions; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007552:Isotonic Solutions / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000077324:Crystalloid Solutions; D007552:Isotonic Solutions