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Changes in circulating blood volume after cardiac surgery measured by a novel method using hydroxyethyl starch

Tschaikowsky, Klaus MD; Neddermeyer, Uwe MD; Pscheidl, Edgar MD; von der Emde, Jürgen MD

Clinical Investigations
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Objective: To determine the incidence and extent of postoperative blood volume (BV) changes in patients after elective cardiac surgery using a new method based on dilution of hydroxyethyl-starch.

Design: Prospective, clinical, and laboratory investigation.

Setting: University hospital intensive care unit.

Patients: A total of thirty-five patients undergoing cardiac surgery requiring cardiopulmonary bypass (CPB).

Interventions: Perioperative measurements of circulating BV, systemic hemodynamics, lactate, and collection of clinical data.

Measurements and Main Results: Measurements were made before and 1 to 72 hrs after CPB. The majority of patients undergoing cardiac surgery showed postoperative BV deficits compared with preoperative BV despite marked positive fluid balances after CPB. At 1 hr and 5 hrs after CPB, 18% and 33% of the patients, respectively, had BV deficits in the range of 0.5 L and 1.5 L, and in 3% to 10% of the cases, postoperative BV deficits exceeded 1.5 L. Concomitantly, at 5 hrs after CPB, mean arterial pressure was maximally reduced, and heart rate and lactate levels were maximally elevated. Thereafter, BV began to normalize, and at 24 hrs after CPB, pre- and postoperative mean BV were no longer significantly different. At 48 hrs and 72 hrs, even a BV surplus of more than 1 L could be observed in 6% and 14% of the patients, respectively.

Conclusions: During the first hours after CPB, a high percentage of patients had significantly reduced BV and, concomitantly, showed cardiovascular dysfunction and hyperlactemia. Because hypovolemia is associated with increases of perioperative morbidity and mortality, rapid determination of BV is warranted to guide fluid therapy and optimize treatment in patients undergoing cardiac surgery.

From the Department of Anesthesiology (Drs. Tschaikowsky, Neddermeyer, and Pscheidl) and Center for Cardiothoracic Surgery (Dr. von der Emde), University of Erlangen-Nümberg, Erlangen, Germany.

Address requests for reprints to: Klaus Tschaikowsky, MD, Department of Anesthesiology, University of Erlangen-Nümberg, Krankenhausstr. 12, D-91054 Erlangen, Germany. E-mail: klaus.tschaikowsky@rzmail.unierlangen.de.

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