Universität zu Köln

Pfortmueller, Carmen A., Faeh, Livia, Mueller, Martin, Eberle, Balthasar, Jenni, Hansjorg, Zante, Bjorn, Prazak, Josef, Englberger, Lars, Takala, Jukka and Jakob, Stephan M. (2019). Fluid management in patients undergoing cardiac surgery: effects of an acetate- versus lactate-buffered balanced infusion solution on hemodynamic stability (HEMACETAT). Crit. Care, 23. LONDON: BMC. ISSN 1364-8535

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Abstract

BackgroundRecent evidence suggests that acetate-buffered infusions result in better hemodynamic stabilization than 0.9% saline in patients undergoing major surgery. The choice of buffer in balanced crystalloid solutions may modify their hemodynamic effects. We therefore compared the inopressor requirements of Ringer's acetate and lactate for perioperative fluid management in patients undergoing cardiac surgery.MethodsUsing a randomized controlled double-blind design, we compared Ringer's acetate (RA) to Ringer's lactate (RL) with respect to the average rate of inopressor administered until postoperative hemodynamic stabilization was achieved. Secondary outcomes were the cumulative dose of inopressors, the duration of inopressor administration, the total fluid volume administered, and the changes in acid-base homeostasis. Patients undergoing elective valvular cardiac surgery were included. Patients with severe cardiac, renal, or liver disease were excluded from the study.ResultsSeventy-five patients were randomly allocated to the RA arm, 73 to the RL. The hemodynamic profiles were comparable between the groups. The groups did not differ with respect to the average rate of inopressors (RA 2.1mcg/kg/h, IQR 0.5-8.1 vs. RL 1.7mcg/kg/h, IQR 0.7-8.2, p=0.989). Cumulative doses of inopressors and time on individual and combined inopressors did not differ between the groups. No differences were found in acid-base parameters and their evolution over time.ConclusionIn this study, hemodynamic profiles of patients receiving Ringer's lactate and Ringer's acetate were comparable, and the evolution of acid-base parameters was similar. These study findings should be evaluated in larger, multi-center studies.Trial registrationClinicaltrials.gov NCT02895659. Registered 16 September 2016.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Pfortmueller, Carmen A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Faeh, Livia UNSPECIFIED UNSPECIFIED UNSPECIFIED Mueller, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED Eberle, Balthasar UNSPECIFIED UNSPECIFIED UNSPECIFIED Jenni, Hansjorg UNSPECIFIED UNSPECIFIED UNSPECIFIED Zante, Bjorn UNSPECIFIED UNSPECIFIED UNSPECIFIED Prazak, Josef UNSPECIFIED UNSPECIFIED UNSPECIFIED Englberger, Lars UNSPECIFIED UNSPECIFIED UNSPECIFIED Takala, Jukka UNSPECIFIED UNSPECIFIED UNSPECIFIED Jakob, Stephan M. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-148522
DOI:	10.1186/s13054-019-2423-8
Journal or Publication Title:	Crit. Care
Volume:	23
Date:	2019
Publisher:	BMC
Place of Publication:	LONDON
ISSN:	1364-8535
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language CORTICAL TISSUE PERFUSION; DOUBLE-BLIND CROSSOVER; BLOOD-FLOW-VELOCITY; 0.9-PERCENT SALINE; SODIUM-ACETATE; THERAPY; RESUSCITATION; PRESSURE; COLLOIDS; MODEL Multiple languages Critical Care Medicine Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/14852