Journal of cardiothoracic and vascular anesthesia · 2010
Volume replacement with a balanced hydroxyethyl starch (HES) preparation in cardiac surgery patients.
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СтатьяРандомизированное исследованиеПоддержка исследования: вне правительства СШАОтозванная публикацияНазвание и аннотация: Перевод в очереди
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Boldt Joachim, Mayer Jochen, Brosch Christian, Lehmann Andreas, Mengistu Andinet
Аннотация
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.
DESIGN: Prospective, randomized, unblinded study.
SETTING: Clinical study in a single cardiac surgery institution.
PARTICIPANTS: Sixty patients undergoing elective cardiac surgery with cardiopulmonary bypass.
INTERVENTION: 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).
MEASUREMENTS AND MAIN 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.
CONCLUSION: 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.
DESIGN: Prospective, randomized, unblinded study.
SETTING: Clinical study in a single cardiac surgery institution.
PARTICIPANTS: Sixty patients undergoing elective cardiac surgery with cardiopulmonary bypass.
INTERVENTION: 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).
MEASUREMENTS AND MAIN 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.
CONCLUSION: 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.
Предметные рубрики MeSH
AgedAged, 80 and overAnesthesiaBlood Loss, SurgicalBlood VolumeCardiac Surgical ProceduresCardiopulmonary BypassCatecholaminesCritical CareDiureticsFemaleFluid TherapyHemodynamicsHemostasisHumansHydroxyethyl Starch DerivativesInflammationKidneyMaleMiddle AgedPlasma SubstitutesPlatelet Function TestsRenal Replacement TherapyThrombelastographyWater-Electrolyte Balance