Skip to main content Skip to main navigation menu Skip to site footer

Comparison of albumin 4%, gelatine, and ringer lactate as volume expander post-resuscitative phase on cardiac output and lactate serum after Coronary Arterial Bypass Grafting (CABG) on-pump: Single-center randomized prospective study

  • Prieta Adriane ,
  • Ni Luh Kusuma Dewi ,
  • Ardiyan Ardiyan ,

Abstract

Background. The use of protein colloid in fluid management post-cardiac surgery is debatable whether it is more beneficial than non-protein colloid or crystalloid. Patients who still need more volume after the resuscitative phase might benefit from optimal fluid management by choosing the most beneficial fluid. This study compared albumin 4% administration to gelatine and ringer lactate as a volume expanders post-resuscitative phase after coronary artery bypass grafting (CABG) on-pump.

Methods. We conducted a single-centered, single-blind, randomized controlled study that assigned 120 patients undergoing elective CABG on-pump. Subjects who met inclusion criteria received 125 ml/hour of either albumin 4%, gelatine colloid, or Ringer's lactate (RL) as the only infusion fluid for 4 hours after the first assessment post-resuscitative phase,  after intensive care unit (ICU) admission. After fluid administration, patients were reassessed. The assessment included cardiac output and lactate serum as the primary outcome, while the duration of mechanical ventilation, ICU, and hospital stay were recorded as secondary outcomes.

Results. The mean of cumulative cardiac output improvement differed between the group albumin 4% 1.18 L/min, gelatine 0.88, and RL 0.74 (p=0.002). Lactate serum decreased in the albumin 4% group as much as 3.31 gr/dl compared to gelatine 2.13 and RL group 2.37 (p=0.005). Duration of mechanical ventilation, length of stay in ICU, and hospital post-operative were shorter in the albumin group than in other groups.

Conclusions. Albumin 4% used as a volume expander in the post-resuscitative phase still improved cardiac output and tissue micro-perfusion than gelatine and ringer lactate.

Section

References

  1. Stephens RS, Whitman GJR. Postoperative Critical Care of the Adult Cardiac Surgical Patient. Part I. Crit Care Med. 2015;43(7):1477–97. Available from: http://dx.doi.org/10.1097/ccm.0000000000001059
  2. Parke RL, McGuinness SP, Gilder E, McCarthy LW. Intravenous fluid use after cardiac surgery: a multicentre, prospective, observational study. Crit Care Resusc. 2014;16(3):164–9.
  3. Hoste EA, Maitland K, Brudney CS, Mehta R, Vincent J-L, Yates D, et al. Four phases of intravenous fluid therapy: a conceptual model. Br J Anaesth. 2014/09/09. 2014;113(5):740–7. Available from: https://pubmed.ncbi.nlm.nih.gov/25204700
  4. Sedrakyan A, Gondek K, Paltiel D, Elefteriades JA. Volume Expansion With Albumin Decreases Mortality After Coronary Artery Bypass Graft Surgerya. Chest. 2003;123(6):1853–7. Available from: http://dx.doi.org/10.1378/chest.123.6.1853
  5. Liumbruno G, Bennardello F, Lattanzio A, Piccoli P, Rossettias G. Recommendations for the use of albumin and immunoglobulins. Blood Transfus. 2009;7(3):216.
  6. Schumacher J, Klotz KF. Fluid therapy in cardiac surgery patients. Appl Cardiopulm Pathophysiol. 2009;13(1):138–42.
  7. Skhirtladze K, Base EM, Lassnigg A, Kaider A, Linke S, Dworschak M, et al. Comparison of the effects of albumin 5%, hydroxyethyl starch 130/0.4 6%, and Ringer’s lactate on blood loss and coagulation after cardiac surgery. Br J Anaesth. 2014;112(2):255–64. Available from: http://dx.doi.org/10.1093/bja/aet348
  8. Diodato M, Chedrawy EG. Coronary artery bypass graft surgery: the past, present, and future of myocardial revascularisation. Surg Res Pract. 2014/01/02. 2014;2014:726158. Available from: https://pubmed.ncbi.nlm.nih.gov/25374960
  9. Singh S, Hutton P. Cerebral effects of cardiopulmonary bypass in adults. BJA CEPD Rev. 2003;3(4):115–9. Available from: http://dx.doi.org/10.1093/bjacepd/mkg115
  10. Hirai S. Systemic inflammatory response syndrome after cardiac surgery under cardiopulmonary bypass. Ann Thorac Cardiovasc Surg. 2003;9(6):365–70.
  11. Engelman DT, Adams DH, Byrne JG, Aranki SF, Collins JJ, Couper GS, et al. Impact of body mass index and albumin on morbidity and mortality after cardiac surgery. J Thorac Cardiovasc Surg. 1999;118(5):866–73. Available from: http://dx.doi.org/10.1016/s0022-5223(99)70056-5
  12. Monteiro J, Goraksha S. ‘ROSE concept’ of fluid management: Relevance in neuroanaesthesia and neurocritical care. J Neuroanaesth Crit Care. 2017;04(01):10–6. Available from: http://dx.doi.org/10.4103/2348-0548.197435
  13. Shaw A, Raghunathan K. Fluid Management in Cardiac Surgery. Anesthesiol Clin. 2013;31(2):269–80. Available from: http://dx.doi.org/10.1016/j.anclin.2012.12.007
  14. Dunn J-OC, Grocott MP, Mythen M (Monty) G. The place of goal-directed haemodynamic therapy in the 21st century. BJA Educ. 2016;16(6):179–85. Available from: http://dx.doi.org/10.1093/bjaed/mkv039
  15. Stephens RS, Whitman GJR. Postoperative Critical Care of the Adult Cardiac Surgical Patient. Part II. Crit Care Med. 2015;43(9):1995–2014. Available from: http://dx.doi.org/10.1097/ccm.0000000000001171
  16. Thompson R, Aya H. Early goal directed therapy following cardiac surgery. ICU Manag Pr. 2014;14(4):4.
  17. Aya HD, Cecconi M, Hamilton M, Rhodes A. Goal-directed therapy in cardiac surgery: a systematic review and meta-analysis. Br J Anaesth. 2013;110(4):510–7. Available from: http://dx.doi.org/10.1093/bja/aet020
  18. van Haren F. Personalised fluid resuscitation in the ICU: still a fluid concept? Crit Care. 2017;21(Suppl 3):313. Available from: https://pubmed.ncbi.nlm.nih.gov/29297387
  19. Malbrain MLNG, Marik PE, Witters I, Cordemans C, Kirkpatrick AW, Roberts DJ, et al. Fluid overload, de-resuscitation, and outcomes in critically ill or injured patients: a systematic review with suggestions for clinical practice. Anestezjol Intens Ter. 2014;46(5):361–80. Available from: http://dx.doi.org/10.5603/ait.2014.0060
  20. Malbrain MLNG, Van Regenmortel N, Saugel B, De Tavernier B, Van Gaal P-J, Joannes-Boyau O, et al. Principles of fluid management and stewardship in septic shock: it is time to consider the four D’s and the four phases of fluid therapy. Ann Intensive Care. 2018;8(1):66. Available from: https://pubmed.ncbi.nlm.nih.gov/29789983
  21. Acheampong A, Vincent J-L. A positive fluid balance is an independent prognostic factor in patients with sepsis. Crit Care. 2015;19(1):251. Available from: https://pubmed.ncbi.nlm.nih.gov/26073560
  22. Morin J-F, Mistry B, Langlois Y, Ma F, Chamoun P, Holcroft C. Fluid Overload after Coronary Artery Bypass Grafting Surgery Increases the Incidence of Post-Operative Complications. World J Cardiovasc Surg. 2011;01(02):18–23. Available from: http://dx.doi.org/10.4236/wjcs.2011.12004
  23. Aronson S, Nisbet P, Bunke M. Fluid resuscitation practices in cardiac surgery patients in the USA: a survey of health care providers. Perioper Med (London, England). 2017;6:15. Available from: https://pubmed.ncbi.nlm.nih.gov/29075482
  24. Jiang Y, Shaw AD. Albumin Supplementation as a Therapeutic Strategy in Cardiac Surgery. Anesthesiology. 2016;124(5):983–5. Available from: http://dx.doi.org/10.1097/aln.0000000000001052
  25. Maes T, Meuwissen A, Diltoer M, Nguyen DN, La Meir M, Wise R, et al. Impact of maintenance, resuscitation and unintended fluid therapy on global fluid load after elective coronary artery bypass surgery. J Crit Care. 2019;49:129–35. Available from: http://dx.doi.org/10.1016/j.jcrc.2018.10.025
  26. Runken MC, Khangulov VS, Munson SH, Peyerl FW, Bunke M. Economic Implications Of Increased Utilization Of 5% Albumin For Fluid Resuscitation Post On-Pump Cardiac Procedures In Us Hospitals. Value Heal. 2015;18(3):A137. Available from: http://dx.doi.org/10.1016/j.jval.2015.03.799
  27. Hoffmann-Petersen J, Leonaviciute D, Jakobsen C-J. Human albumin has greater impact on outcomes after cardiac surgery than hydroxyl-ethyl starches and crystalloids - an epidemiologic study. J Cardiothorac Vasc Anesth. 2016;30:S22. Available from: http://dx.doi.org/10.1053/j.jvca.2016.03.067
  28. Hosseinzadeh Maleki M, Derakhshan P, Rahmanian Sharifabad A, Amouzeshi A. Comparing the Effects of 5% Albumin and 6% Hydroxyethyl Starch 130/0.4 (Voluven) on Renal Function as Priming Solutions for Cardiopulmonary Bypass: A Randomized Double Blind Clinical Trial. Anesthesiol pain Med. 2016;6(1):e30326–e30326. Available from: https://pubmed.ncbi.nlm.nih.gov/27110527
  29. Wigmore GJ, Anstey JR, St. John A, Greaney J, Morales-Codina M, Presneill JJ, et al. 20% Human Albumin Solution Fluid Bolus Administration Therapy in Patients After Cardiac Surgery (the HAS FLAIR Study). J Cardiothorac Vasc Anesth. 2019;33(11):2920–7. Available from: http://dx.doi.org/10.1053/j.jvca.2019.03.049
  30. Parke RL, McGuinness SP, Gilder E, McCarthy LW, Cowdrey K-AL. A Randomised feasibility study to assess a novel strategy to rationalise fluid in patients after cardiac surgery. Br J Anaesth. 2015;115(1):45–52. Available from: http://dx.doi.org/10.1093/bja/aev118

How to Cite

Adriane, P., Dewi, N. L. K., & Ardiyan, A. (2022). Comparison of albumin 4%, gelatine, and ringer lactate as volume expander post-resuscitative phase on cardiac output and lactate serum after Coronary Arterial Bypass Grafting (CABG) on-pump: Single-center randomized prospective study. Intisari Sains Medis, 13(1), 102–108. https://doi.org/10.15562/ism.v13i1.1043

HTML
55

Total
49

Share

Search Panel