The influence of a balanced volume replacement concept on inflammation, endothelial activation, and kidney integrity in elderly cardiac surgery patients

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. In a randomized clinical trial, 50 patients aged >75 years undergoing cardiac surgery received a balance...

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Published in:Intensive care medicine 2009-03, Vol.35 (3), p.462-470
Main Authors: BOLDT, Joachim, SUTTNER, Stephan, BROSCH, Christian, LEHMANN, Andreas, RÖHM, Kerstin, MENGISTU, Andinet
Format: Article
Language:English
Subjects:
Acid-Base Equilibrium
Acidosis
Aged
Aged, 80 and over
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Cardiac Output - physiology
Cardiac Surgical Procedures - statistics & numerical data
Creatinine
Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care
Endothelium, Vascular - drug effects
Female
Heart Rate - physiology
Heart surgery
Humans
Hypovolemia - therapy
Inflammation - therapy
Intensive care
Intensive care medicine
Intercellular Adhesion Molecule-1 - metabolism
Isotonic Solutions - therapeutic use
Male
Medical sciences
Metabolism
Postoperative Period
Pulmonary arteries
Pulmonary Wedge Pressure
Renal Insufficiency - prevention & control
Sodium Chloride - therapeutic use
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Summary: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. 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. 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. 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.
ISSN:0342-4642
1432-1238
DOI:10.1007/s00134-008-1287-1