Use of 3% hypertonic saline versus hetastarch for initial volume resuscitation after cardiopulmonary bypass surgery

Dennis Wang, Jose A. Acosta, Michael Hockstein, Peter M Rhee, Arthur St Andre

Research output: Contribution to journalArticle

Abstract

Introduction: Colloid has been the standard initial volume resuscitation fluid after cardiopulmonary bypass surgery (CPB). The combination of hypertonic saline and colloid has been shown to improve cardiorespiratory functions and microcirculation. Hetastarch (HES) can result in coagulopathy and is more expansive when compared with 3% hypertonic saline (HTS). Therefore, we wanted to determine if HTS is safe and efficacious when compared to HES after CPB. Methods: Prospectively collected data on all patients that underwent CPB over 15 months were analyzed. HTS (up to 1 liter) was used as the initial volume resuscitation fluid in a non-randomized subgroup of patients. Concurrent cohorts who received HES as the initial resuscitation fluid were controls. Indications for volume resuscitation were hypotension and/or poor perfusion with low filling pressure. Patients requiring additional fluid resuscitation after 1 liter of HTS were given HES as needed. The volume of fluids received, outcome variables (mortality, resource utilization, bleeding, and use of vasoconstrictors) were compared. Student's t test is used for continuous variables and Chi-square for nominal variables. Statistical significance is define at p<0.05. Results: 946 patients received HTS as their initial fluid resuscitation out of a total of 2006 patients. The two groups have no statistical difference in pre-operative and operative parameters (age,sex, pre-operative EF, New York Heart Association Class,type of surgery, bypass time, estimated blood lost, post-operative temperature). HTS group received an average of 845ml of HTS and 67.0% needed additional HES. The HTS group required 555ml of HES, significantly less whenc ompared to 891ml for the control group. HTS group received significantly less packed red cells (429ml vs. 595ml and 38.7% vs. 54.0%). HTS patients also have significantly lower reoperation rate for bleeding (2.33% vs. 5.47%). There were no statistical differences in outcome parameters (survival, ICU length of stay, ventilator days, total hospital length of stay). Conclusions: Patients who received 3% hypertonic saline for initial volume resuscitation after cardiopulmonary bypass surgeries required less HES, blood transfusion and were less likely to need re-operation for bleeding. 3% hypertonic saline is an effective and safe initial resuscitation fluid for patients that underwent cardiopulmonary bypass surgery.

Original languageEnglish (US)
JournalCritical Care Medicine
Volume27
Issue number12 SUPPL.
StatePublished - 1999
Externally publishedYes

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Hydroxyethyl Starch Derivatives
Cardiopulmonary Bypass
Resuscitation
Length of Stay
Colloids
Hemorrhage
Vasoconstrictor Agents
Mechanical Ventilators
Microcirculation
Reoperation
Blood Transfusion
Hypotension
Perfusion
Students
Pressure
Control Groups
Temperature
Survival

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Use of 3% hypertonic saline versus hetastarch for initial volume resuscitation after cardiopulmonary bypass surgery. / Wang, Dennis; Acosta, Jose A.; Hockstein, Michael; Rhee, Peter M; Andre, Arthur St.

In: Critical Care Medicine, Vol. 27, No. 12 SUPPL., 1999.

Research output: Contribution to journalArticle

Wang, Dennis ; Acosta, Jose A. ; Hockstein, Michael ; Rhee, Peter M ; Andre, Arthur St. / Use of 3% hypertonic saline versus hetastarch for initial volume resuscitation after cardiopulmonary bypass surgery. In: Critical Care Medicine. 1999 ; Vol. 27, No. 12 SUPPL.
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abstract = "Introduction: Colloid has been the standard initial volume resuscitation fluid after cardiopulmonary bypass surgery (CPB). The combination of hypertonic saline and colloid has been shown to improve cardiorespiratory functions and microcirculation. Hetastarch (HES) can result in coagulopathy and is more expansive when compared with 3{\%} hypertonic saline (HTS). Therefore, we wanted to determine if HTS is safe and efficacious when compared to HES after CPB. Methods: Prospectively collected data on all patients that underwent CPB over 15 months were analyzed. HTS (up to 1 liter) was used as the initial volume resuscitation fluid in a non-randomized subgroup of patients. Concurrent cohorts who received HES as the initial resuscitation fluid were controls. Indications for volume resuscitation were hypotension and/or poor perfusion with low filling pressure. Patients requiring additional fluid resuscitation after 1 liter of HTS were given HES as needed. The volume of fluids received, outcome variables (mortality, resource utilization, bleeding, and use of vasoconstrictors) were compared. Student's t test is used for continuous variables and Chi-square for nominal variables. Statistical significance is define at p<0.05. Results: 946 patients received HTS as their initial fluid resuscitation out of a total of 2006 patients. The two groups have no statistical difference in pre-operative and operative parameters (age,sex, pre-operative EF, New York Heart Association Class,type of surgery, bypass time, estimated blood lost, post-operative temperature). HTS group received an average of 845ml of HTS and 67.0{\%} needed additional HES. The HTS group required 555ml of HES, significantly less whenc ompared to 891ml for the control group. HTS group received significantly less packed red cells (429ml vs. 595ml and 38.7{\%} vs. 54.0{\%}). HTS patients also have significantly lower reoperation rate for bleeding (2.33{\%} vs. 5.47{\%}). There were no statistical differences in outcome parameters (survival, ICU length of stay, ventilator days, total hospital length of stay). Conclusions: Patients who received 3{\%} hypertonic saline for initial volume resuscitation after cardiopulmonary bypass surgeries required less HES, blood transfusion and were less likely to need re-operation for bleeding. 3{\%} hypertonic saline is an effective and safe initial resuscitation fluid for patients that underwent cardiopulmonary bypass surgery.",
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T1 - Use of 3% hypertonic saline versus hetastarch for initial volume resuscitation after cardiopulmonary bypass surgery

AU - Wang, Dennis

AU - Acosta, Jose A.

AU - Hockstein, Michael

AU - Rhee, Peter M

AU - Andre, Arthur St

PY - 1999

Y1 - 1999

N2 - Introduction: Colloid has been the standard initial volume resuscitation fluid after cardiopulmonary bypass surgery (CPB). The combination of hypertonic saline and colloid has been shown to improve cardiorespiratory functions and microcirculation. Hetastarch (HES) can result in coagulopathy and is more expansive when compared with 3% hypertonic saline (HTS). Therefore, we wanted to determine if HTS is safe and efficacious when compared to HES after CPB. Methods: Prospectively collected data on all patients that underwent CPB over 15 months were analyzed. HTS (up to 1 liter) was used as the initial volume resuscitation fluid in a non-randomized subgroup of patients. Concurrent cohorts who received HES as the initial resuscitation fluid were controls. Indications for volume resuscitation were hypotension and/or poor perfusion with low filling pressure. Patients requiring additional fluid resuscitation after 1 liter of HTS were given HES as needed. The volume of fluids received, outcome variables (mortality, resource utilization, bleeding, and use of vasoconstrictors) were compared. Student's t test is used for continuous variables and Chi-square for nominal variables. Statistical significance is define at p<0.05. Results: 946 patients received HTS as their initial fluid resuscitation out of a total of 2006 patients. The two groups have no statistical difference in pre-operative and operative parameters (age,sex, pre-operative EF, New York Heart Association Class,type of surgery, bypass time, estimated blood lost, post-operative temperature). HTS group received an average of 845ml of HTS and 67.0% needed additional HES. The HTS group required 555ml of HES, significantly less whenc ompared to 891ml for the control group. HTS group received significantly less packed red cells (429ml vs. 595ml and 38.7% vs. 54.0%). HTS patients also have significantly lower reoperation rate for bleeding (2.33% vs. 5.47%). There were no statistical differences in outcome parameters (survival, ICU length of stay, ventilator days, total hospital length of stay). Conclusions: Patients who received 3% hypertonic saline for initial volume resuscitation after cardiopulmonary bypass surgeries required less HES, blood transfusion and were less likely to need re-operation for bleeding. 3% hypertonic saline is an effective and safe initial resuscitation fluid for patients that underwent cardiopulmonary bypass surgery.

AB - Introduction: Colloid has been the standard initial volume resuscitation fluid after cardiopulmonary bypass surgery (CPB). The combination of hypertonic saline and colloid has been shown to improve cardiorespiratory functions and microcirculation. Hetastarch (HES) can result in coagulopathy and is more expansive when compared with 3% hypertonic saline (HTS). Therefore, we wanted to determine if HTS is safe and efficacious when compared to HES after CPB. Methods: Prospectively collected data on all patients that underwent CPB over 15 months were analyzed. HTS (up to 1 liter) was used as the initial volume resuscitation fluid in a non-randomized subgroup of patients. Concurrent cohorts who received HES as the initial resuscitation fluid were controls. Indications for volume resuscitation were hypotension and/or poor perfusion with low filling pressure. Patients requiring additional fluid resuscitation after 1 liter of HTS were given HES as needed. The volume of fluids received, outcome variables (mortality, resource utilization, bleeding, and use of vasoconstrictors) were compared. Student's t test is used for continuous variables and Chi-square for nominal variables. Statistical significance is define at p<0.05. Results: 946 patients received HTS as their initial fluid resuscitation out of a total of 2006 patients. The two groups have no statistical difference in pre-operative and operative parameters (age,sex, pre-operative EF, New York Heart Association Class,type of surgery, bypass time, estimated blood lost, post-operative temperature). HTS group received an average of 845ml of HTS and 67.0% needed additional HES. The HTS group required 555ml of HES, significantly less whenc ompared to 891ml for the control group. HTS group received significantly less packed red cells (429ml vs. 595ml and 38.7% vs. 54.0%). HTS patients also have significantly lower reoperation rate for bleeding (2.33% vs. 5.47%). There were no statistical differences in outcome parameters (survival, ICU length of stay, ventilator days, total hospital length of stay). Conclusions: Patients who received 3% hypertonic saline for initial volume resuscitation after cardiopulmonary bypass surgeries required less HES, blood transfusion and were less likely to need re-operation for bleeding. 3% hypertonic saline is an effective and safe initial resuscitation fluid for patients that underwent cardiopulmonary bypass surgery.

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