VOLUME THERAPY IN Cardiac Surgery PATIENTS

Posted by e-Medical PPT Tuesday, December 31, 2013
The goal of fluid management and inotropic and vasoactive drug therapy in post-operative cardiac surgery patients is to achieve sufficient tissue perfusion and a normalization of oxidative metabolism.

Cardiac output and oxygen supply are dependent on adequate intravascular volume and cardiac function.

The following parameters are recommended as goals for postoperative cardiovascular therapies.

Fluid management:
In cardiac surgery patients it is common to have relative or absolute volume deficiency in the early post operative phase.
First line treatment in cardiac surgery intensive care medicine consists in the use of artificial colloid solutions.
Medium molecular weight HES derivatives (Voluven) are preferred.
Crystalloid solutions are the second choice of volume substitution.
Plasma volume substitution with human albumin is no longer used in 50% of cardiac surgery intensive care units.

High molecular weight HES (Hespan):
High molecular weight HES (>200 kDa) 10% preparations (Hespan) is associated with increased postoperative bleeding.
High molecular weight HES, hyperoncotic colloids and 10% and 20% albumin, are associated with increased risk of hyperoncotic renal failure.
Hespan is contraindicated in patients with severe increases of Na & Cl.

Medium molecular weight HES (Voluven):

Medium molecular weight HES (130 kDa) 6% (Voluven) is not associated with increased postoperative bleeding.
Medium molecular weight HES (130 kDa) 6% (Voluven) is not associated with increased risk of hyperoncotic renal failure.
There is no scientific evidence to support the use of the more expensive albumin over medium molecular weight (130 kDa) 6% HES preparations.
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