Abstract
BackgroundIntraoperative and postoperative management of cardiac surgery patients is complex, involving the application of differential vasopressors and volume therapy. It has been shown that a positive fluid balance has a major impact on postoperative outcome. Today, the advantages and disadvantages of buffered crystalloid solutes are a topic of controversy, with no consensus being reached so far. The use of hypertonic saline (HS) has shown promising results with respect to lower total fluid balance and postoperative weight gain in critically ill patients in preliminary studies. However, collection of more data on HS in critically ill patients seems warranted. This preliminary study aims to investigate whether fluid resuscitation using HS in patients following cardiac surgery results in less total fluid volume being administered.MethodsIn a prospective double-blind randomised controlled clinical trial, we aim to recruit 96 patients undergoing elective cardiac surgery for ischaemic and/or valvular heart disease. After postoperative admission to the intensive care unit (ICU), patients will be randomly assigned to receive 5 ml/kg ideal body weight HS (7.3% NaCl) or normal saline (NS, 0.9% NaCl) infused within 60 min. Blood and urine samples will be collected preoperatively and postoperatively up to day 6 to assess changes in renal, cardiac, inflammatory, acid-base, and electrolyte parameters. Additionally, we will perform renal ultrasonography studies to assess renal blood flow before, during, and after infusion, and we will measure total body water using preoperative and postoperative body composition analysis (bioimpedance). Patients will be followed up for 90 days.DiscussionThe key objective of this study is to assess the cumulative amount of fluid administered in the intervention (HS) group versus control (NS) group during the ICU stay. In this preliminary, prospective, randomised controlled clinical trial we will test the hypothesis that use of HS results in less total fluids infused and less postoperative weight gain when compared to the standard of intensive care in cardiac surgery patients.Trial registrationClinicalTrials.gov, NCT03280745. Registered on 12 September 2017.
Highlights
Intraoperative and postoperative management of cardiac surgery patients is complex, involving the application of differential vasopressors and volume therapy
We propose a preliminary prospective, single-centre, randomised controlled clinical trial on the use of hypertonic saline (HS) (7.3% NaCl) versus Normal saline (NS) (0.9% NaCl) in addition to conventional fluid resuscitation with lactated Ringer’s solution in patients after cardiac surgery
Patients undergoing cardiac surgery typically receive a significant amount of intravenous fluids to support circulatory function and counteract the side effects of rewarming after cardiopulmonary bypass [10]
Summary
Intraoperative and postoperative management of cardiac surgery patients is complex, involving the application of differential vasopressors and volume therapy. It has been shown that a positive fluid balance has a major impact on postoperative outcome. The use of hypertonic saline (HS) has shown promising results with respect to lower total fluid balance and postoperative weight gain in critically ill patients in preliminary studies. Collection of more data on HS in critically ill patients seems warranted This preliminary study aims to investigate whether fluid resuscitation using HS in patients following cardiac surgery results in less total fluid volume being administered. According to a recent large multicentre survey conducted in Germany, crystalloids are considered the fluid of choice for intraoperative fluid therapy, cardiopulmonary bypass circuit priming, and post-surgery intensive care [1]
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