Key result
7.5% hypertonic saline/6% HES significantly increased cardiac index compared to 6% HES (3.6 vs 3.0 l/min/M2, p<0.05) in patients undergoing abdominal aortic reconstruction.
Why the study?
Does 7.5% hypertonic saline / 6% hydroxyethyl starch improve haemodynamics and oxygen transport in patients undergoing abdominal aortic reconstruction?
RCT (n=50)
randomised
No
Does 7.5% hypertonic saline / 6% hydroxyethyl starch improve haemodynamics and oxygen transport in patients undergoing abdominal aortic reconstruction?
Absolute Event Rate: 3.6% vs 3%
p-value: p=<0.05
In patients undergoing abdominal aortic reconstruction, 7.5% hypertonic saline with 6% HES improves haemodynamics and reduces intraoperative fluid requirements compared to 6% HES alone, though it increases the risk of hypokalaemia.
Supports hypertonic saline/HES for hemodynamic optimization in aortic reconstruction; extends small-volume resuscitation evidence to high-risk vascular procedures.
Objective: To evaluate the effects of 7.5% hypertonic saline / 6% hydroxyethyl starch (HES) against 6% HES as control on haemodynamics, oxygen transport patterns and selected metabolic parameters in patients undergoing abdominal aortic reconstruction. Design: Prospective, randomised controlled study. Setting: Operating theatre and general intensive care unit in a university hospital. Subjects: Fifty patients undergoing abdominal aortic reconstruction were randomised to receive either 7.5% hypertonic saline/6% HES (HTS-HES group, n=25) or 6% HES (HES group, n=25) after aortic clamp release. Measurements and main results: Compared to 6% HES, 7.5% NaCl/6% HES produced a significant increase in cardiac index (3.6±0.9 versus 3.0±0.8 l/min/M2, p<0.05) and a significantly higher mean arterial pressure at the end of surgery (103±14 versus 94±14 mmHg). Oxygen consumption index (VO2I) was significantly higher in the control group of patients given 6% HES after infusion and at the end of surgery (102±23 versus 83±25 and 109±31 versus 92±26 ml/min/M2, respectively, p<0.05). Infusion of HTS-HES caused an increase in plasma volume (2.1±0.3 versus 1.9±0.3 litres, p<0.05), and was associated with a significant sodium load (147±4 versus 138±2 mmol/l, p<0.001), which persisted throughout the early post-operative period. Twelve patients (48%) in the HTS-HES subgroup were hypokalaemic and needed potassium supplementation intraoperatively. The amount of fluid given intra-operatively was greater in patients given 6% HES (3.8±0.8 versus 2.9±0.3 litres, p<0.05). Conclusion: Compared to 6% HES, 7.5% NaCl/6% HES caused a significant increase in volume expansion and improvement in haemodynamics, as well as reducing intraoperative fluid requirements in patients undergoing abdominal aortic reconstruction.
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Sobczyński et al. (1997) conducted an RCT in abdominal aortic reconstruction (n=50). 7.5% hypertonic saline / 6% hydroxyethyl starch vs. 6% hydroxyethyl starch was evaluated on cardiac index (l/min/M2) (p=<0.05). 7.5% hypertonic saline/6% HES significantly increased cardiac index compared to 6% HES (3.6 vs 3.0 l/min/M2, p<0.05) in patients undergoing abdominal aortic reconstruction.
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