Intensive Care Medicine

, Volume 34, Issue 10, pp 1796–1803

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 

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)

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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