Document Detail


Effects of hypertonic saline-dextran solution in cardiac valve surgery with cardiopulmonary bypass.
MedLine Citation:
PMID:  14759446     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Hypertonic saline-dextran (HSD) solution may be beneficial in patients undergoing coronary artery surgery with cardiopulmonary bypass. Valvular dysfunction is associated with high pulmonary wedge pressure, pulmonary hypertension, and ventricular dysfunction. Fluid overload or transient left ventricular failure may occur with HSD infusion in such patients. This study evaluates the cardiorespiratory effects and tolerance of HSD solution infusion in patients undergoing cardiac valve surgery. METHODS: This prospective, randomized, double-blind study compared clinical, laboratory, hemodynamic, and respiratory measurements, and fluid balance in 50 patients over a 48-hour period after cardiopulmonary bypass for cardiac valve surgery. Twenty-five patients received 4 mL/kg of HSD during 20 minutes before cardiopulmonary bypass (HSD group). The control group received the same volume of Ringer's solution (Ringer group). RESULTS: Hospital mortality was zero. The HSD patients had a near zero fluid balance (6.5 +/- 13.5 mL/Kg/48 hours), and the control patients had a positive balance (91.0 +/- 33.7 mL/Kg/48 hours). Hemoglobin was similar in both groups, but more blood transfusions were necessary in the Ringer group (1.21 +/- 1.28 vs 0.48 +/- 0.59 units per patients). The HSD solution induced a higher cardiac index and left ventricular systolic work index postoperatively, and a lower systemic vascular resistance index until 6, 24, and 48 hours. Right ventricular systolic work index increased and pulmonary vascular resistance index decreased after HSD infusion. A better Pao(2)/Fio(2) relation was observed at 1 and 6 hours postoperatively in the HSD group and was associated with a shorter extubation time (432.0 +/- 123.6 vs 520.8 +/- 130.2 minutes). Increased oxygen delivery index occurred in the HSD group. The HSD infusion was well tolerated as none of the patients experienced fluid overload or had left ventricular failure develop. No other complication attributable to the use of HSD solution was observed. CONCLUSIONS: The HSD solution infusion in patients during cardiac valve surgery with cardiopulmonary bypass was well tolerated. Hemodynamic and respiratory functions improved and fluid balance was near zero during the first 48 hours as compared with a large positive balance in the control group. We conclude that HSD infusion is advantageous for patients undergoing cardiac valve surgery.
Authors:
Ronaldo Bueno; Adailton Carvalho Resende; Ricardo Melo; Vicente Avila Neto; Noedir A G Stolf
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  77     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2004 Feb 
Date Detail:
Created Date:  2004-02-04     Completed Date:  2004-03-17     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  604-11; discussion 611     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiovascular Surgery, Beneficência Portuguesa Hospital, São Paulo, Brazil. rmbueno@matrix.com.br
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MeSH Terms
Descriptor/Qualifier:
Adult
Brazil
Cardiopulmonary Bypass*
Dextrans / administration & dosage*,  adverse effects
Double-Blind Method
Female
Follow-Up Studies
Heart Valve Diseases / surgery*
Heart Valve Prosthesis Implantation*
Hemodynamics / drug effects
Humans
Male
Middle Aged
Outcome and Process Assessment (Health Care)
Oxygen Consumption / drug effects
Prospective Studies
Saline Solution, Hypertonic / administration & dosage*,  adverse effects
Water-Electrolyte Balance / drug effects
Chemical
Reg. No./Substance:
0/Saline Solution, Hypertonic; 9004-54-0/Dextrans

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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