Intensive Care Medicine

, Volume 35, Issue 3, pp 462–470

RETRACTED ARTICLE: The influence of a balanced volume replacement concept on inflammation, endothelial activation, and kidney integrity in elderly cardiac surgery patients

  • Joachim Boldt
  • Stephan Suttner
  • Christian Brosch
  • Andreas Lehmann
  • Kerstin Röhm
  • Andinet Mengistu
Original

Abstract

Purpose

A balanced fluid replacement strategy appears to be promising for correcting hypovolemia. The benefits of a balanced fluid replacement regimen were studied in elderly cardiac surgery patients.

Methods

In a randomized clinical trial, 50 patients aged >75 years undergoing cardiac surgery received a balanced 6% HES 130/0.42 plus a balanced crystalloid solution (n = 25) or a non-balanced HES in saline plus saline solution (n = 25) to keep pulmonary capillary wedge pressure/central venous pressure between 12–14 mmHg. Acid-base status, inflammation, endothelial activation (soluble intercellular adhesion molecule-1, kidney integrity (kidney-specific proteins glutathione transferase-alpha; neutrophil gelatinase-associated lipocalin) were studied after induction of anesthesia, 5 h after surgery, 1 and 2 days thereafter. Serum creatinine (sCr) was measured approximately 60 days after discharge.

Results

A total of 2,750 ± 640 mL of balanced and 2,820 ± 550 mL of unbalanced HES were given until the second POD. Base excess (BE) was significantly reduced in the unbalanced (from +1.21 ± 0.3 to −4.39 ± 1.0 mmol L−1 5 h after surgery; P < 0.001) and remained unchanged in the balanced group (from 1.04 ± 0.3 to −0.81 ± 0.3 mmol L−1 5 h after surgery). Evolution of the BE was significantly different. Inflammatory response and endothelial activation were significantly less pronounced in the balanced than the unbalanced group. Concentrations of kidney-specific proteins after surgery indicated less alterations of kidney integrity in the balanced than in the unbalanced group.

Conclusions

A total balanced volume replacement strategy including a balanced HES and a balanced crystalloid solution resulted in moderate beneficial effects on acid-base status, inflammation, endothelial activation, and kidney integrity compared to a conventional unbalanced volume replacement regimen.

Keywords

Volume replacement Balanced volume replacement Hydroxethylstarch Inflammation Kidney function Cardiac surgery 

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Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Joachim Boldt
    • 1
  • Stephan Suttner
    • 1
  • Christian Brosch
    • 1
  • Andreas Lehmann
    • 1
  • Kerstin Röhm
    • 1
  • Andinet Mengistu
    • 1
  1. 1.Department of Anesthesiology and Intensive Care MedicineKlinikum der Stadt LudwigshafenLudwigshafenGermany

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