Retracted: Influence of Hypertonic Volume Replacement on the Microcirculation in Cardiac Surgery

Abstract

We have studied the effects of two types of volume replacement on the microcirculation in an open, controlled study in 45 patients undergoing aorto-coronary bypass grafting whose pulmonary capillary wedge pressure (PCWP) was less than 5 mm Hg. Hypertonic saline prepared in hydroxyethylstarch solution (HS-HES, n = 15) and 6% HES 200/0.5 solution (6% HES; n = 15) were infused randomly before operation in order to double the PCWP. Patients not given an infusion served as controls (n = 15). Skin microcirculatory blood flow was investigated by laser Doppler flow (LDF) measured simultaneously at the forearm and forehead before and after cardiopulmonary bypass (CPB). Less HS-HES (3.8 (SD 0.3) ml kg-1) than 6% HES-solution (9.7 (1.5) ml kg-1) was necessary to double baseline PCWP. There were no differences in heart rate and mean arterial pressure (MAP) between the groups. Cardiac index (CI) increased significantly in both volume groups (HS-HES max. +54%; 6% HES max. +30%). Systemic vascular resistance (SVR) decreased after infusion of HS-HES (-30%) and after 6% HES(-19%) and remained almost unchanged in the control group. Plasma viscosity decreased after infusion of HS-HES and increased slightly in control patients (+4%). In comparison with the 6% HES and particularly with the control group, LDF was significantly greater after infusion of HS-HES (forearm +80%; forehead +28%). LDF during CPB and thereafter was always greater than baseline values in the HS-HES group, whereas after bypass LDF was reduced in the 6% HES (-5%) and particularly in the control patients (-30%).(ABSTRACT TRUNCATED AT 250 WORDS)

Le s�rum sal� hypertonique en 2004

“…En chirurgie cardiaque, le SSH améliore significativement la microcirculation tissulaire avant, pendant et après la CEC [75]. Lors du remplissage vasculaire en postopératoire (chirurgie de la valve mitrale), le SSH seul ou associé à un HEA est très efficace, avec une augmentation de la précharge et de la fraction d'éjection du ventricule gauche ; mais ces effets restent transitoires (durée inférieure à trois heures) et l'association du SSH à un colloïde ne les prolonge pas [76].…”

Hypertonic Solutions May Prevent Multiple Organ Failure in Humans: Myth or Reality?

“…[13][14][15][16] In JOACHIM BOLDT Figure 1 a study in cardiac surgery patients, it was shown that preoperative infusion of hypertonic solution prepared in HES 200/0.5 (HHS) resulted in a significantly improved microcirculation measured by laser Doppler flowmetry (LDF) before, during, and after CPB, which may be beneficial for patients' outcome ( Figure 3). 17 …”

Safety and efficacy of hypertonic saline versus isotonic saline solution in off-pump coronary artery bypass grafting

“…2 Studies have shown that hypertonic solutions whether combined with colloids such as dextran or 6% hydroxyethyl starch or not promote a negative water balance, improved cardiac output, decreased systemic vascular resistance and reduce the need for blood products. [3][4][5][6][7][8][9] These benefits have also been shown for volume replacement with hypertonic solutions during the postoperative period following off-pump coronary artery bypass grafting. 10 Off-pump coronary artery bypass grafting reduces blood losses, myocardial infarction, acute renal failure, mediastinitis, stroke and prolonged orotracheal intubation particularly in subgroups of higher-risk patients.…”