Hypertonic Solution Decreases Extravascular Lung Water in Cardiac Patients Undergoing Cardiopulmonary Bypass Surgery

• Published in: Journal of cardiothoracic and vascular anesthesia Vol. 27; no. 2; pp. 273 - 282
• Main Authors: Lomivorotov, Vladimir V., MD, PhD, Fominskiy, Evgeniy V., MD, Efremov, Sergey M., MD, PhD, Nepomniashchikh, Valeriy A., MD, PhD, Lomivorotov, Vladimir N., MD, PhD, Chernyavskiy, Alexander M., MD, PhD, Shilova, Anna N., MD, PhD, Karaskov, Alexander M., MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2013
• Subjects: Aged; Anesthesia & Perioperative Care; Cardiac Output - drug effects; Cardiac Surgical Procedures; Cardiopulmonary Bypass; coronary artery bypass grafting; Critical Care; Double-Blind Method; Extravascular Lung Water - drug effects; extravascular lung water index; Female; Hemodynamics - physiology; Humans; Hydroxyethyl Starch Derivatives - therapeutic use; hypertonic solution; Lung - drug effects; Lung - physiology; Male; Middle Aged; Osmolar Concentration; Plasma Substitutes - therapeutic use; Postoperative Complications - epidemiology; Postoperative Complications - prevention & control; Postoperative Period; Prospective Studies; pulmonary function; Respiratory Function Tests; Saline Solution, Hypertonic - therapeutic use; Sodium - blood; Water-Electrolyte Balance - physiology; extravascular lung water index; pulmonary function; cardiopulmonary bypass; hypertonic solution; coronary artery bypass grafting
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2012.06.013

Objective To test the hypothesis that the infusion of hypertonic solution would decrease extravascular lung water postoperatively and thus improve pulmonary function. Design Prospective, randomized, blinded trial. Setting Tertiary cardiothoracic referral center. Participants Twenty-six patients with coronary artery disease who underwent surgery with cardiopulmonary bypass (CPB). Interventions Patients were allocated randomly to receive 4 mL/kg of 7.2% NaCl/hydroxyethyl starch, 200/0.5 (HSH group) or an equal volume of 0.9% NaCl (control group) for 30 minutes starting after anesthesia induction. The extravascular lung water index, hemodynamic and biochemical data, and the rate of complications were analyzed. Measurements and Main Results The extravascular lung water index was significantly lower (7 v 9.5 mL/kg) in the HSH group at the first postoperative day ( p < 0.01). The index of arterial oxygenation efficiency was significantly higher at 5 minutes and 2 and 4 hours after cardiopulmonary bypass (CPB) in the HSH group ( p < 0.05). The alveolar-arterial oxygen tension difference was significantly lower at 5 minutes and 2 and 4 hours after CPB in the HSH group ( p < 0.01). The cardiac index was significantly higher at 5 minutes after infusion in the HSH group ( p < 0.05). Conclusions The infusion of HSH leads to significant decreases in the extravascular lung water index during and after cardiac surgery and is associated with better preservation of pulmonary function and transient increases in the cardiac index. Further trials are needed to clarify the clinical advantages of hypertonic solution administration in patients undergoing surgery with CPB.