D Ernest1, A S Belzberg, P M Dodek. 1. Program in Critical Care Medicine, Center for Health Evaluation and Outcome Sciences, St. Paul's Hospital and University of British Columbia, Vancouver, BC, Canada. ernest@sub.net.au
Abstract
OBJECTIVE: To determine the relative distribution of fluid within the extracellular fluid volume (ECFV) and the effect on oxygen delivery after infusing either normal saline or 5% albumin in cardiac surgical patients. DESIGN: Prospective, randomized, unblinded, interventional study. SETTING:Cardiac surgical intensive care unit in a 450-bed teaching hospital. PATIENTS: Postoperative cardiac surgical patients (n = 40). INTERVENTIONS: Infusion of either normal saline or 5% albumin to a hemodynamic end point determined by the patient's clinician. MEASUREMENTS AND MAIN RESULTS:Plasma volume (PV), ECFV, cardiac index, and arterial oxygen content were measured immediately before (baseline) and after each fluid infusion. PV and ECFV were measured by dilution of (131)I-albumin and [(35)S]sodium sulfate, respectively. Interstitial fluid volume (ISFV) was calculated as ECFV - PV. Baseline values for PV, ISFV, ECFV, and oxygen delivery index did not differ between treatment groups. Infusion of normal saline and 5% albumin increased PV by 9 +/- 23% and 52 +/- 84% of the volume infused, respectively (p <.05), whereas there was no significant difference between saline and albumin in the change in ISFV per volume infused. Only 5% albumin significantly increased cardiac index, although oxygen delivery did not change significantly after either infusion. CONCLUSIONS: In postoperative cardiac surgical patients, infusion of 5% albumin is approximately five times as efficient as a PV expander but has comparable effects on changes in ISFV and oxygen delivery relative to normal saline.
RCT Entities:
OBJECTIVE: To determine the relative distribution of fluid within the extracellular fluid volume (ECFV) and the effect on oxygen delivery after infusing either normal saline or 5% albumin in cardiac surgical patients. DESIGN: Prospective, randomized, unblinded, interventional study. SETTING: Cardiac surgical intensive care unit in a 450-bed teaching hospital. PATIENTS: Postoperative cardiac surgical patients (n = 40). INTERVENTIONS: Infusion of either normal saline or 5% albumin to a hemodynamic end point determined by the patient's clinician. MEASUREMENTS AND MAIN RESULTS: Plasma volume (PV), ECFV, cardiac index, and arterial oxygen content were measured immediately before (baseline) and after each fluid infusion. PV and ECFV were measured by dilution of (131)I-albumin and [(35)S]sodium sulfate, respectively. Interstitial fluid volume (ISFV) was calculated as ECFV - PV. Baseline values for PV, ISFV, ECFV, and oxygen delivery index did not differ between treatment groups. Infusion of normal saline and 5% albumin increased PV by 9 +/- 23% and 52 +/- 84% of the volume infused, respectively (p <.05), whereas there was no significant difference between saline and albumin in the change in ISFV per volume infused. Only 5% albumin significantly increased cardiac index, although oxygen delivery did not change significantly after either infusion. CONCLUSIONS: In postoperative cardiac surgical patients, infusion of 5% albumin is approximately five times as efficient as a PV expander but has comparable effects on changes in ISFV and oxygen delivery relative to normal saline.
Authors: Joanne Verheij; Arthur van Lingen; Albertus Beishuizen; Herman M T Christiaans; Jan R de Jong; Armand R J Girbes; Willem Wisselink; Jan A Rauwerda; Marinus A J M Huybregts; A B Johan Groeneveld Journal: Intensive Care Med Date: 2006-05-23 Impact factor: 17.440
Authors: Chiedozie I Udeh; Jing You; Matthew R Wanek; Jarrod Dalton; Belinda L Udeh; Sevag Demirjian; Nadeem Rahman; J Steven Hata Journal: Perioper Med (Lond) Date: 2018-12-14
Authors: Matthias Jacob; Daniel Chappell; Peter Conzen; Mahlon M Wilkes; Bernhard F Becker; Markus Rehm Journal: Crit Care Date: 2008-03-04 Impact factor: 9.097