A comparison of the hemodynamic effects of fluid bolus therapy with crystalloids vs. 4% albumin and vs. 20% albumin in patients after cardiac surgery

• Published in: Heart & lung 2021-11, Vol.50 (6), p.870-876
• Main Authors: Yanase, Fumitaka, Cutuli, Salvatore L, Naorungroj, Thummaporn, Bitker, Laurent, Wilson, Anthony, Eastwood, Glenn M, Bellomo, Rinaldo
• Format: Article
• Language: English
• Subjects: albumin; Albumins; cardiac index; cardiac surgery; Cardiac Surgical Procedures; crystalloid; Crystalloid Solutions; Fluid bolus; Fluid Therapy; Hemodynamics; Humans; Life Sciences
• ISSN: 0147-9563; 1527-3288
• DOI: 10.1016/j.hrtlng.2021.07.014

•The hemodynamic effect of a post-cardiac surgery fluid bolus remains unstudied.•Compared to albumins, a crystalloid fluid bolus showed a faster MAP decline. Background: Crystalloids, 4% albumin and 20% albumin are used for fluid bolus therapy (FBT) in patients after cardiac surgery. However, their detailed early (30 min) hemodynamic effects remain unstudied. Methods: In a comparative prospective observational trial of 120 ventilated, we studied post cardiac surgery patients who received crystalloid 500 ml FBT, 4% albumin 500 ml FBT or 20% albumin 100 ml FBT (40 per group). We recorded second-by-second hemodynamic parameters and 15-minutely cardiac index (CI) data before and for 30 min after FBT. We compared the crystalloid group (reference) vs. the 4% albumin group, and vs. the 20% albumin group. Results: Immediately after FBT, the mean (standard deviation) CI increase was 0.4 (0.4) L/min/m2 with crystalloids, 0.4 (0.5) L/min/m2 with 4% albumin and 0.3 (0.4) L/min/m2 with 20% albumin, despite the much smaller FBT volume with 20% albumin. Mean arterial pressure (MAP) increase was 11 (10), 12 (9) and 9 (6) mm Hg, respectively. There was no group effect or interaction for changes in CI. However, there were time-group interactions for MAP changes such that crystalloid FBT had faster MAP reduction than 4% (p