Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-23T12:28:08.041Z Has data issue: false hasContentIssue false
  • English
  • Français

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
Get access

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Olthof CG, Jansen PG, de Vries JP et al. Interstitial fluid volume during cardiac surgery measured by means of a non-invasive conductivity technique. Acta Anaesthesiol Scand 1995; 39: 508–512.Google Scholar
Koller ME, Bert J, Segadal L, Reed RK. Estimation of total body fluid shifts between plasma and interstitium in man during extracorporeal circulation. Acta Anaesthesiol Scand 1992; 36: 255–259.Google Scholar
Geissler HJ, Allen SJ. Myocardial fluid balance: pathophysiology and clinical implications. Thorac Cardiovasc Surg 1998; 46 (Suppl 2): 242–245.Google Scholar
Hachenberg T, Tenling A, Rothen HU, Nystrom SO, Tyden H, Hedenstierna G. Thoracic intravascular and extravascular fluid volumes in cardiac surgical patients. Anesthesiology 1993; 79: 976–984.Google Scholar
Riegger LQ, Voepel-Lewis T, Kulik TJ et al. Albumin versus crystalloid prime solution for cardiopulmonary bypass in young children. Crit Care Med 2002; 30: 2649–2654.Google Scholar
Eising GP, Niemeyer M, Gunther T et al. Does a hyperoncotic cardiopulmonary bypass prime affect extravascular lung water and cardiopulmonary function in patients undergoing coronary artery bypass surgery? Eur J Cardiothorac Surg 2001; 20: 282–289.Google Scholar
Sade RM, Stroud MR, Crawford Jr FA, Kratz JM, Dearing JP, Bartles DM. A prospective randomized study of hydroxyethyl starch, albumin, and lactated Ringer's solution as priming fluid for cardiopulmonary bypass. J Thorac Cardiovasc Surg 1985; 89: 713–722.Google Scholar
Levy JH, Tanaka KA. Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg 2003; 75: S715–S720.Google Scholar
Wan S, LeClerc JL, Vincent JL. Inflammatory response to cardiopulmonary bypass: mechanisms involved and possible therapeutic strategies. Chest 1997; 112: 676–692.Google Scholar
Chenoweth DE, Cooper SW, Hugli TE, Stewart RW, Blackstone EH, Kirklin JW. Complement activation during cardiopulmonary bypass: evidence for generation of C3a and C5a anaphylatoxins. New Engl J Med 1981; 304: 497–503.Google Scholar
Heltne JK, Bert J, Lund T et al. Temperature-related fluid extravasation during cardiopulmonary bypass: an analysis of filtration coefficients and transcapillary pressures. Acta Anaesthesiol Scand 2002; 46: 51–56.Google Scholar
Mehlhorn U, Davis KL, Burke EJ, Adams D, Laine GA, Allen SJ. Impact of cardiopulmonary bypass and cardioplegic arrest on myocardial lymphatic function. Am J Physiol 1995; 268: H178–H183.Google Scholar
Hoeft A, Korb H, Mehlhorn U, Stephan H, Sonntag H. Priming of cardiopulmonary bypass with human albumin or Ringer lactate: effect on colloid osmotic pressure and extravascular lung water. Br J Anaesth 1991; 66: 73–80.Google Scholar
Mehlhorn U, Allen SJ, Adams DL et al. Normothermic continuous antegrade blood cardioplegia does not prevent myocardial edema and cardiac dysfunction. Circulation 1995; 92: 1940–1946.Google Scholar
Jansen PG, te Velthuis H, Wildevuur WR et al. Cardiopulmonary bypass with modified fluid gelatin and heparincoated circuits. Br J Anaesth 1996; 76: 13–19.Google Scholar
Scott DA, Hore PJ, Cannata J, Masson K, Treagus B, Mullaly J. A comparison of albumin, polygeline and crystalloid priming solutions for cardiopulmonary bypass in patients having coronary artery bypass graft surgery. Perfusion 1995; 10: 415–424.Google Scholar
Marelli D, Paul A, Samson R, Edgell D, Angood P, Chiu RC. Does the addition of albumin to the prime solution in cardiopulmonary bypass affect clinical outcome? A prospective randomized study. J Thorac Cardiovasc Surg 1989; 98: 751–756.Google Scholar
Boldt J. Volume therapy in cardiac surgery: does the kind of fluid matter? J Cardiothorac Vasc Anesth 1999; 13: 752–763.Google Scholar
London MJ. Pro: colloids should be added to the pump prime. J Cardiothorac Anesth 1990; 4: 401–405.Google Scholar
D'Ambra MN, Philbin DM. Con: colloids should not be added to the pump prime. J Cardiothorac Anesth 1990; 4: 406–408.Google Scholar
Mehlhorn U, Allen SJ, Davis KL, Geissler HJ, Warters RD, Rainer de Vivie E. Increasing the colloid osmotic pressure of cardiopulmonary bypass prime and normothermic blood cardioplegia minimizes myocardial oedema and prevents cardiac dysfunction. Cardiovasc Surg 1998; 6: 274–281.Google Scholar
Davis KL, Mehlhorn U, Laine GA, Allen SJ. Myocardial edema, left ventricular function, and pulmonary hypertension. J Appl Physiol 1995; 78: 132–137.Google Scholar
Hoeft A, Schorn B, Weyland A et al. Bedside assessment of intravascular volume status in patients undergoing coronary bypass surgery. Anesthesiology 1994; 81: 76–86.Google Scholar
Lichtwarck-Aschoff M, Leucht S, Kisch HW, Zimmermann G, Blumel G, Pfeiffer UJ. Monitoring of right ventricular function using a conventional slow response thermistor catheter. Intens Care Med 1994; 20: 348–353.Google Scholar
von Spiegel T, Giannaris S, Wietasch GJ et al. Effects of dexamethasone on intravascular and extravascular fluid balance in patients undergoing coronary bypass surgery with cardiopulmonary bypass. Anesthesiology 2002; 96: 827–834.Google Scholar
Buhre W, Weyland A, Schorn B et al. Changes in central venous pressure and pulmonary capillary wedge pressure do not indicate changes in right and left heart volume in patients undergoing coronary artery bypass surgery. Eur J Anaesthesiol 1999; 16: 11–17.Google Scholar
Buhre W, Hoeft A, Schorn B, Weyland A, Scholz M, Sonntag H. Acute affect of mitral valve replacement on extravascular lung water in patients receiving colloid or crystalloid priming of cardiopulmonary bypass. Br J Anaesth 1997; 79: 311–316.Google Scholar
English TA, Kirklin JW, Digerness S. Changes in colloid osmotic pressure during and shortly after open intracardiac operation. J Thorac Cardiovasc Surg 1971; 61: 338–341.Google Scholar
Jarvela K, Koskinen M, Kaukinen S, Koobi T. Effects of hypertonic saline (7.5%) on extracellular fluid volumes compared with normal saline (0.9%) and 6% hydroxyethyl starch after aortocoronary bypass graft surgery. J Cardiothorac Vasc Anesth 2001; 15: 210–215.Google Scholar
Heltne JK, Koller ME, Lund T et al. Studies on fluid extravasation related to induced hypothermia during cardiopulmonary bypass in piglets. Acta Anaesthesiol Scand 2001; 45: 720–728.Google Scholar
Tassani P, Schad H, Winkler C et al. Capillary leak syndrome after cardiopulmonary bypass in elective, uncomplicated coronary artery bypass grafting operations: does it exist? J Thorac Cardiovasc Surg 2002; 123: 735–741.Google Scholar
Falk JL, Rackow EC, Weil MH. Colloid and crystalloid fluid resuscitation. Acute Care 1983; 10: 59–94.Google Scholar
Ernest D, Belzberg AS, Dodek PM. Distribution of normal saline and 5% albumin infusions in septic patients. Crit Care Med 1999; 27: 46–50.Google Scholar
Levy JH, Kelly AB. Inflammation and cardiopulmonary bypass. Can J Anaesth 1993; 40: 1009–1015.Google Scholar
Ernest D, Belzberg AS, Dodek PM. Distribution of normal saline and 5% albumin infusions in cardiac surgical patients. Crit Care Med 2001; 29: 2299–2302.Google Scholar
Arndt JO. The low pressure system: the integrated function of veins. Eur J Anaesthesiol 1986; 3: 343–370.Google Scholar