Fluid management in patients undergoing cardiac surgery: effects of an acetate- versus lactate-buffered balanced infusion solution on hemodynamic stability (HEMACETAT)
type: Article
item type: journalArticle
is part of: Crit Care
authors: Person
  surname: Pfortmueller
  given name: C. A.
authors: Person
  surname: Faeh
  given name: L.
authors: Person
  surname: Muller
  given name: M.
authors: Person
  surname: Eberle
  given name: B.
authors: Person
  surname: Jenni
  given name: H.
authors: Person
  surname: Zante
  given name: B.
authors: Person
  surname: Prazak
  given name: J.
authors: Person
  surname: Englberger
  given name: L.
authors: Person
  surname: Takala
  given name: J.
authors: Person
  surname: Jakob
  given name: S. M.
subject: Aged
subject: Blood Gas Analysis
subject: Buffers
subject: Cardiac Surgical Procedures/methods/standards
subject: Cardiac surgical procedures
subject: Crystalloid solutions
subject: Double-Blind Method
subject: Female
subject: Fluid Therapy/methods/*standards
subject: Fluid therapy
subject: Hemodynamics
subject: Hemodynamics/*drug effects
subject: Humans
subject: Isotonic Solutions/adverse effects/*pharmacology/therapeutic use
subject: Linear Models
subject: Male
subject: Middle Aged
subject: Monitoring, Physiologic/methods/statistics & numerical data
subject: Perioperative period
subject: Randomized controlled trial
subject: Ringer's Lactate/adverse effects/*pharmacology/therapeutic use
subject: Time Factors
subject: Vasoconstrictor agents
subject: committee of the Canton of Berne. CONSENT FOR PUBLICATION: All authors give their
subject: consent for publication. COMPETING INTERESTS: The authors declare that they have
subject: no competing interests. PUBLISHER'S NOTE: Springer Nature remains neutral with
subject: regard to jurisdictional claims in published maps and institutional affiliations.
abstract: BACKGROUND: Recent evidence suggests that acetate-buffered infusions result in better hemodynamic stabilization than 0.9% saline in patients undergoing major surgery. The choice of buffer in balanced crystalloid solutions may modify their hemodynamic effects. We therefore compared the inopressor requirements of Ringer's acetate and lactate for perioperative fluid management in patients undergoing cardiac surgery. METHODS: Using a randomized controlled double-blind design, we compared Ringer's acetate (RA) to Ringer's lactate (RL) with respect to the average rate of inopressor administered until postoperative hemodynamic stabilization was achieved. Secondary outcomes were the cumulative dose of inopressors, the duration of inopressor administration, the total fluid volume administered, and the changes in acid-base homeostasis. Patients undergoing elective valvular cardiac surgery were included. Patients with severe cardiac, renal, or liver disease were excluded from the study. RESULTS: Seventy-five patients were randomly allocated to the RA arm, 73 to the RL. The hemodynamic profiles were comparable between the groups. The groups did not differ with respect to the average rate of inopressors (RA 2.1 mcg/kg/h, IQR 0.5-8.1 vs. RL 1.7 mcg/kg/h, IQR 0.7-8.2, p = 0.989). Cumulative doses of inopressors and time on individual and combined inopressors did not differ between the groups. No differences were found in acid-base parameters and their evolution over time. CONCLUSION: In this study, hemodynamic profiles of patients receiving Ringer's lactate and Ringer's acetate were comparable, and the evolution of acid-base parameters was similar. These study findings should be evaluated in larger, multi-center studies. TRIAL REGISTRATION: Clinicaltrials.gov NCT02895659 . Registered 16 September 2016.
date: 2019-05-08
pages: 159
coverage: 31060591

Crit Care
type: Journal
volume: 23
number: 1
identifier: DOI 10.1186/s13054-019-2423-8
identifier: ISSN 1466-609X (Electronic) 1364-8535 (Print) 1364-8535 (Linking)