Abstract
Purpose
To compare the efficacy of volume expansion with 3.5% gelatin and 6% hydroxyethyl starch 200/0.5 in patients undergoing cardiac surgery. The second objective was to compare the two colloids in terms of blood losses and allogeneic blood transfusion exposure rate.
Methods
In this open-label controlled study patients were randomly allocated to receive either 3.5% urea-linked gelatin (GEL group:n = 55) or 6% hydroxyethyl starch 200/0.5/5.1 (HES group:n = 55) for per-(including priming of the bypass machine) and post-operative volume management with a maximum dosage of 30 ± 3 mL·kg−1·day−1. Volume replacement was guided according to routine per- and postoperative care based on cardiac index, mixed venous oxygen saturation, and diuresis. If additional colloid was required, 4.5% albumin had to be given. The study period comprised per- and postoperative investigations up to 18 hr after surgery.
Results
All hemodynamic variables were comparable in both groups. Total study drug was 25.8 ± 4.8 mL·kg−1 in the GEL group and 24.5 ±6.0 mL·kg−1in the HES group. There was no difference in the number of patients receiving albumin solution or in the amount of albumin administered. Total blood loss was higher in the HES than in the GEL group (11.0 ± 7.8 mL·kg−1 vs 8.7 ± 4.0 mL·kg−1;P < 0.05) resulting in a higher need for allogeneic blood transfusion (HES: nine patients received 12 units, GEL two patients received 3 units;P = 0.026).
Conclusion
In the conditions of the present study, HES was not associated with a better plasma expansion effect than GEL. HES could result in a higher need for allogeneic blood transfusion.
Résumé
Objectif
Comparer l’efficacité de l’expansion volumique avec de la gélatine à 3,5 % et de l’hydroxyéthylamidon 200/0,5 à 6% chez des patients de cardiochirurgie. Comparer aussi les colloïdes en termes de pertes sanguines et de taux d’exposition à une transfusion de sang allogénique.
Méthode
Pour notre étude ouverte et contrôlée, des patients ont été répartis au hasard et ont reçu soit de la gélatine à pont d’urée à 3,5 % (groupe GEL: n = 55), soit de l’hydroxyéthylamidon 200/0,5/5, 1 à 6 % (groupe HEA: n = 55) pour le remplissage vasculaire peropératoire (incluant le volume d’amorçage de la CEC) et postopératoire avec une dose maximale de 30 ± 3 mL·kg−1·jour−1. Le remplissage vasculaire a été réalisé selon les méthodes habituelles fondées sur l’index cardiaque, la saturation en oxygène du sang veineux mêlé et la diurèse. Si un colloïde supplémentaire était nécessaire, de l’albumine à 4,5 % était administrée. Létude comprenait les investigations peropératoires et postopératoires jusqu’à 18 h après l’opération.
Résultats
Toutes les variables hémodynamiques étaient comparables dans les deux groupes. La moyenne du total de médicament utilisé a été de 25,8 ± 4,8 mL·kg−1 dans le groupe GEL et de 24,5 ± 6,0 mL·kg−1 dans le groupe HEA. Il n’y a pas eu de différence quant au nombre de patients qui ont reçu une solution d’albumine ou quant à la quantité d’albumine administrée. Les pertes sanguines totales ont été plus élevées avec l’HEA qu’avec la GEL (11,0 ± 7,8 mL·kg−1 vs 8,7 ± 4,0 mL·kg−1; P < 0,05) provoquant une demande plus importante de transfusion de sang allogénique (groupe HEA: neuf patients ont reçu 12 unités; groupe GEL: deux patients ont reçu 3 unités; P = 0,026).
Conclusion
Dans les conditions de la présente étude, l’HEA n’a pas été associé à une meilleure expansion plasmatique que la GEL. L’HEA peut entraîner de plus grands besoins de transfusion sanguine allogénique.
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Supported by a grant from Fresenius Kabi GmbH, Bad Homburg, Germany.
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Van der Linden, P.J., De Hert, S.G., Daper, A. et al. 3.5% urea-linked gelatin is as effective as 6% HES 200/0.5 for volume management in cardiac surgery patients. Can J Anesth 51, 236–241 (2004). https://doi.org/10.1007/BF03019102
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DOI: https://doi.org/10.1007/BF03019102