Intensive Care Medicine

, Volume 34, Issue 10, pp 1796–1803 | Cite as

Half-molar sodium-lactate solution has a beneficial effect in patients after coronary artery bypass grafting

  • Xavier M. Leverve
  • Cindy Boon
  • Tarmizi Hakim
  • Maizul Anwar
  • Erwin Siregar
  • Iqbal Mustafa
Original

Abstract

Objective

To compare two solutions for fluid resuscitation in post-coronary artery bypass grafting (CABG) surgery patients: Ringer’s lactate (RL) versus a new solution containing half-molar sodium-lactate (HL).

Design

Prospective randomized open label study.

Setting

The first 12 h post-CABG surgery in an intensive care unit (ICU).

Patients

There were 230 patients enrolled in the study: 208 were analyzed, with 109 from the HL group and 99 from the RL group.

Interventions

Patients received over the first 12 h post-CABG 10 ml kg BW−1 HL solution in the HL group versus 30 ml kg BW−1 of RL solution in the RL group.

Measurements and results

Hemodynamic status, body fluid balance and inotrope utilization were compared in the two groups. Post-operative cardiac index increase was significantly higher in HL than in RL (P = 0.02), while mean arterial pressure and other hemodynamic parameters were comparable together with urinary output, indicating similar tissue perfusion in both the groups despite a much lower fluid infusion in the HL group. Therefore, a significant negative fluid balance was achieved in the HL but not in the RL group (−790 ± 71 vs. +43 ± 115 mL 12 h−1, P < 0.0001 for HL and RL, respectively). None of the enrolled patients exhibited side effects related to the treatment.

Conclusion

Half-molar lactate solution is effective for fluid resuscitation in post-CABG patients. Compared to Ringer’s Lactate, its use results in a significantly higher cardiac index with less volume being infused, resulting in a very negative post-operative body fluid balance.

Keywords

CABG Hypertonic lactate Fluid resuscitation Hemodynamic Efficacy Safety 

Notes

Acknowledgments

This study was sponsored by Innogene Kalbiotech, Pte. Ltd., 24 Raffles Place 27 – 06 Clifford Centre, Singapore 048621. The half-molar sodium-lactate containing solution is patented (WO 2004/096204 -11/11/04, Gazette 2004/46) and registered (Totilac™). We are grateful to Mr. Gareth Butt for his English corrections to this paper.

Disclosure of interest

Professor Xavier Leverve is member of the Innogene International Scientific Board Advisors.

Supplementary material

134_2008_1165_MOESM1_ESM.ppt (271 kb)
Fig. 1bis (electronic supplementary material). Effect of RL versus HL on heart rate, cardiac filling pressures, mean pulmonary artery pressure and vascular resistance. Open symbols: RL, closed symbols: HL. Panel A: Heart Rate (B/min); Panel B: Central Venous Pressure (CVP), mm Hg; panel C: Mean Pulmonary Artery Pressure (MPAP), mm Hg; Panel D: Pulmonary Artery Occluded Pressure (PAOP), mm Hg; panel E: Pulmonary Vascular Resistance Index (PVRI), dyne.s.cm−5; panel DF: Systemic Vascular Resistance Index (SVRI), dyne.s.cm−5. Results are expressed as means±sem; statistical comparisons with ANOVA for repeated measures: NS for all parameters, PVRI excepted: p=0.0367 (post hoc analysis: 2h p=0.004; 3h p=0.023; 5h p=0.011) (PPT 271 kb)

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Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Xavier M. Leverve
    • 1
  • Cindy Boon
    • 2
  • Tarmizi Hakim
    • 3
  • Maizul Anwar
    • 3
  • Erwin Siregar
    • 2
  • Iqbal Mustafa
    • 4
  1. 1.LBFA, INSERM-U884Université Joseph-FourierGrenoble CedexFrance
  2. 2.Department of AnesthesiologyHarapan Kita National Cardiovascular CenterJakartaIndonesia
  3. 3.Department of Cardiothoracic SurgeryHarapan Kita National Cardiovascular CenterJakartaIndonesia
  4. 4.Intensive Care UnitHarapan Kita National Cardiovascular CenterJakartaIndonesia

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