Abstract
Purpose
A balanced fluid replacement strategy appears to be promising for correcting hypovolemia. The benefits of a balanced fluid replacement regimen were studied in elderly cardiac surgery patients.
Methods
In a randomized clinical trial, 50 patients aged >75 years undergoing cardiac surgery received a balanced 6% HES 130/0.42 plus a balanced crystalloid solution (n = 25) or a non-balanced HES in saline plus saline solution (n = 25) to keep pulmonary capillary wedge pressure/central venous pressure between 12–14 mmHg. Acid-base status, inflammation, endothelial activation (soluble intercellular adhesion molecule-1, kidney integrity (kidney-specific proteins glutathione transferase-alpha; neutrophil gelatinase-associated lipocalin) were studied after induction of anesthesia, 5 h after surgery, 1 and 2 days thereafter. Serum creatinine (sCr) was measured approximately 60 days after discharge.
Results
A total of 2,750 ± 640 mL of balanced and 2,820 ± 550 mL of unbalanced HES were given until the second POD. Base excess (BE) was significantly reduced in the unbalanced (from +1.21 ± 0.3 to −4.39 ± 1.0 mmol L−1 5 h after surgery; P < 0.001) and remained unchanged in the balanced group (from 1.04 ± 0.3 to −0.81 ± 0.3 mmol L−1 5 h after surgery). Evolution of the BE was significantly different. Inflammatory response and endothelial activation were significantly less pronounced in the balanced than the unbalanced group. Concentrations of kidney-specific proteins after surgery indicated less alterations of kidney integrity in the balanced than in the unbalanced group.
Conclusions
A total balanced volume replacement strategy including a balanced HES and a balanced crystalloid solution resulted in moderate beneficial effects on acid-base status, inflammation, endothelial activation, and kidney integrity compared to a conventional unbalanced volume replacement regimen.
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References
Hill GE (1998) Cardiopulmonary bypass-induced inflammation: is it important? J Cardiothorac Vasc Anesth 12(Suppl):S21–S25
Mythen MG, Salmon JB, Webb AR (1993) The rational administration of colloids. Blood Rev 7:223–228
Cussak RJ, Ball JAS, Rhdes A, Grounds RM (2002) Improving postoperative morbidity and mortality. Intensiv Med 39:571–577
Lacy JH, Wright CB (1992) Use of plasma volume expanders in myocardial revascularisation. Drugs 44:720–727
Boldt J (2007) Pro: use of colloids in cardiac surgery. J Cardiothorac Vasc Anesth 21:453–456
Nuttall GA, Oliver WC (2007) Con: use of colloids in cardiac surgery. J Cardiothorac Vasc Anesth 21:453–456
Zander R (2006) Infusion fluids: why should they be balanced solution? EJHP Pract 12:1–4
Gan TJ, Bennett-Guerrero E, Phillips-Bute B, Wakeling H, Moskowitz DM, Olufolabi Y, Konstadt SN, Bradford C, Glass PS, Machin SJ, Mythen MG (1999) Hextend, a physiologically balanced plasma expander for large volume use in major surgery: a randomized phase III clinical trial. Anesth Analg 88:992–998
Wilkes NJ, Woolf R, Mutch M, Mallett SV, Peachey T, Stephens R, Mythen MG (2001) The effects of balanced versus saline-based hetastarch and crystalloid solutions on acid-base and electrolyte status and gastric mucosal perfusion in elderly surgical patients. Anesth Analg 93:811–816
Wilkes NJ, Woolf RL, Powanda MC, Gan TJ, Machin SJ, Webb A, Mutch M, Bennett-Guerrero E, Mythen M (2002) Hydroxyethyl starch in balanced electrolyt solution (Hextend®)—pharmacokinetic and pharmacodynamic profiles in healthy volunteers. Anesth Analg 94:538–544
Kozek-Langenecker SA (2005) Effects of hydroxyethyl starch solutions on hemostasis. Anesthesiology 103:654–660
Jungheinrich C, Neff TA (2005) Pharmacokinetics of hydroxyethyl starch. Clin Pharmacokinet 44:681–699
Boldt J Schöllhorn T, Schulte G, Pabsdorf M (2006) Volume replacement with a new balanced hydroxyethylstarch preparation (HES 130/0.42) in patients undergoing major abdominal surgery. EJA 231–239
Haynes GH, Havidich JE, Payne KJ (2004) Why the Food and Drug Administration changed the warning label for hetastarch. Anesthesiology 101:560–561
Franz A, Bräunlich P, Gamsjäger T, Felfernig M, Gustorff B, Kozek-Langenecker SA (2001) The effects of hydroxyethyl starches of varying molecular weights on platelet function. Anesth Analg 92:1402–1407
Waitzinger J, Bepperling F, Pabst G, Opitz J (1998) Pharmacokinetics and tolerability of a new hydroxyethylstarch (HES) specification (HES 130/0.4) after single-dose infusion of 6% or 10% solution in healthy volunteers. Clin Drug Invest 16:151–160
L Rink, I Cakman, Kirchner H (1998) Altered cytokine production in the elderly. Mech Aging Dev 102:199–209
Zaidi AM, Fitzpatrick AP, Keenan DJ, Odom NJ, Grotte GJ (1999) Good outcomes from cardiac surgery in the over 70s. Heart 82:134–137
Kellum JA (2002) Saline-induced hyperchloremic metabolic acidosis. Crit Care Med 30:259–261
Base E, Standl T, Mahl C, Jungheinrich C (2006) Comparison of 6% HES 130/0.4 in a balanced electrolyte solution versus 6% HES 130/0.4 in saline solution in cardiac surgery. Crit Care 10(Suppl 1):P176
Conlon PJ, Stafford-Smith M, White WD, White WD, Newman MF, King S, Winn MP, Landolfo K (1999) Acute renal failure following cardiac surgery. Nephrol Dial Transplant 14:1158–1162
Mills GH (2007) Hydroxyethyl starch: does our choice of colloid prevent or add renal impairment? Br J Anaesth 98:157–159
Wiedermann CJ (2004) Hydroxyethyl starch—can the safety problems be ignored? Wien Klin Wochenschr 116:583–594
Legendre C, Thervet E, Page B, Percheron A, Noël LH, Kreis H (1993) Hydroxyethylstarch and osmotic-nephrosis-like lesions in kidney transplantation. Lancet 342:248–249
Winkelmayer WC, Glynn RJ, Levin R, Avorn J (2003) Hydroxyethyl starch and change in renal function in patients undergoing coronary artery bypass graft surgery. Kidney Int 64:1046–1049
Brunkhorst FM, Engel C, Bloos F, Ragaller M, Weiler N, Moerer O, Gruendling M, Oppert M, Grond S, Olthoff D, Jaschinski U, John S, Rossaint R, Welte T, Schaefer M, Kern P, Kuhnt E, Kiehntopf M, Hartog C, Natanson C, Loeffler M, Reinhart K, German Competence Network Sepsis (SepNet) (2008) Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med 358:125–139
Quilley CP, Lin YS, McGiff JC (1993) Chloride anion concentration as a determinant of renal vascular responsiveness to vasoconstrictor agents. Br J Pharmacol 108:106–110
Wilcox CS (1983) Regulation of renal blood flow by plasma chloride. J Clin Invest 71:726–735
Kotchen TA, Luke RG, Ott CE, Galla JH, Whitescarver S (1983) Effect of chloride on renin and blood pressure responses to sodium chloride. Ann Intern Med 98:817–822
Han WK, Bonventre JV (2004) Biologic markers for the early detection of acute kidney injury. Curr Opin Crit Care 10:476–482
Mishra J, Ma Q, Prada A, Zahedi K, Yang J, Barasch J, Devarajan P (2003) Identification of neutrophil gelatinase-associated lipocalin as a novel urinary biomarker for ischemic injury. J Am Soc Nephrol 14:2534–2543
Kellum JA, Song M, Almasri E (2006) Hyperchloremic acidosis increases circulating inflammatory molecules in experimental sepsis. Chest 130:962–967
Finfer S, Bellomo R, Boyce N (2004) A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 350:2247–2256
Roche AM, James MF, Bennett-Guerrero E, Mythen MG (2006) A head-to-head comparison of the in vitro coagulation effects of saline-based and balanced electrolyte crystalloid and colloid intravenous fluids. Anesth Analg 102:1274–1279
Leverve XM, Boon C, Hakim T, Anwar M, Siregar E, Mustafa I (2008) Half-molar sodium-lactate solution has a beneficial effect in patients after coronary artery bypass grafting. Intensive Care Med. doi:10.1007/s00134-008-1165-x
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This study was supported only by a hospital grant.
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This article has been retracted as the IRB approval for the research was misrepresented.
An erratum to this article is available at http://dx.doi.org/10.1007/s00134-011-2220-6.
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Boldt, J., Suttner, S., Brosch, C. et al. RETRACTED ARTICLE: The influence of a balanced volume replacement concept on inflammation, endothelial activation, and kidney integrity in elderly cardiac surgery patients. Intensive Care Med 35, 462–470 (2009). https://doi.org/10.1007/s00134-008-1287-1
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DOI: https://doi.org/10.1007/s00134-008-1287-1