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Intra- and extravascular volume status in patients undergoing mitral valve replacement: crystalloid vs. colloid priming of cardiopulmonary bypass

Published online by Cambridge University Press:  23 December 2005

S. Rex ,
M. Scholz ,
A. Weyland ,
T. Busch ,
B. Schorn  and
W. Buhre
S. Rex
Affiliation:
Klinik für Anästhesiologie, Universitätsklinikum der RWTH Aachen, Aachen, Germany
M. Scholz
Affiliation:
Klinik und Poliklinik für Anästhesiologie und spezielle Intensivmedizin der Universität Bonn, Bonn, Germany
A. Weyland
Affiliation:
Klinik für Anästhesiologie und Intensivmedizin, Klinikum Oldenburg, Oldenburg, Germany
T. Busch
Affiliation:
Klinik für Thorax-, Herz- und Gefäβchirurgie, Universitätsklinikum der RWTH Aachen, Aachen, Germany
B. Schorn
Affiliation:
Klinik für Gefäβ- und Thoraxchirurgie, Märkische Kliniken, Lüdenscheid, Germany
W. Buhre
Affiliation:
University Medical Center Utrecht, Division of Perioperative Care and Emergency Care, Department of Anaesthesiology, GA Utrecht, The Netherlands
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Extract

Summary

Background and objective: Cardiopulmonary bypass is associated with changes of intra- and extravascular volume status often resulting in cardiopulmonary dysfunction. The purpose of this prospective double-blind study was to evaluate the influence of different priming solutions of the extracorporeal circuit on intra- and extravascular volume status and haemodynamics in patients undergoing elective mitral valve replacement. Methods: Twenty-two patients with mitral valve insufficiency were randomly allocated into two equal groups. In Group 1 cardiopulmonary bypass was primed with a nearly isooncotic solution consisting of 4% albumin. The second group received a pure crystalloid priming solution. The thermo-dye indicator dilution technique was used for the assessment of cardiac output, central and pulmonary blood volume, right ventricular end-diastolic volume and total blood volume. Results: Patients in the crystalloid group showed increased intraoperative fluid requirements. Significantly more fluid was accumulated in the extravascular space whereas total blood volume was decreased after surgery. Stroke volume index (SVI) was significantly decreased in the immediate postoperative period when compared to baseline. As indicated by the increase in extravascular fluid content after surgery, both colloid and crystalloid priming volumes were transferred to the extravascular space. Conclusion: The use of colloid priming solutions in patients with mitral valve insufficiency leads to less fluid requirements and significantly reduced fluid shift in the interstitium. However, these changes are not associated with changes in haemodynamic parameters or short term outcome.

Keywords

CARDIOPULMONARY BYPASSINFUSIONS INTRAVENOUS, crystalloid, colloidFLUID THERAPYVENTRICULAR FUNCTION, LEFTHEART FUNCTION TESTS
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 1 , January 2006 , pp. 1 - 9
Copyright
© 2006 European Society of Anaesthesiology

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