Full Text View
Temperature and haemodynamic effects of a 100 mL bolus of 20% albumin at room versus body temperature in cardiac surgery patients
Fumitaka Yanase, Salvatore L Cutuli, Thummaporn Naorungroj, Laurent Bitker, Alessandro Belletti, Anthony Wilson, Glenn M Eastwood, Rinaldo Bellomo
Crit Care Resusc 2021; 23 (1): 14-23
- Fumitaka Yanase 1, 2
- Salvatore L Cutuli 1, 3
- Thummaporn Naorungroj 1, 4
- Laurent Bitker 1, 5
- Alessandro Belletti 1, 6
- Anthony Wilson 1, 7
- Glenn M Eastwood 1
- Rinaldo Bellomo 1, 2, 8
OBJECTIVE: To study the temperature and haemodynamic effects of room versus body temperature 20% albumin fluid bolus therapy (FBT). DESIGN: Single-centre, prospective, before–after trial.SETTING: A tertiary intensive care unit (ICU) in Australia.
PARTICIPANTS: Sixty ventilated post-cardiac surgery patients.
INTERVENTION: Room versus body temperature 100 mL 20% albumin FBT.
MAIN OUTCOME MEASURES: We recorded haemodynamic data from FBT start to 30 minutes after FBT. The cardiac index (CI) response was defined by a CI increase > 15%, and the mean arterial pressure (MAP) response was defined by a MAP increase > 10%.
OUTCOMES: Immediately after FBT, median blood temperature decreased by -0.1°C (interquartile range [IQR], -0.1 to 0.0°C) with room temperature albumin versus 0.0°C (IQR, -0.1 to 0.0°C) with body temperature albumin (P < 0.001). The CI or MAP responses were similar. There was, however, a time and study group interaction for blood temperature (P < 0.001) for absolute and relative changes. In addition, mean pulmonary arterial pressure (PAP) (P = 0.002) increased more with body temperature albumin and remained higher for most of the observation period.
CONCLUSION: Compared with room temperature albumin FBT, body temperature 20% albumin FBT prevents FBT-associated blood temperature fall and increases mean PAP. However, CI and MAP changes were the similar between the two groups, implying that fluid temperature has limited haemodynamic effects in these patients.
- Fischer GW, Levin MA. Vasoplegia during cardiac surgery: current concepts and management. Semin Thorac Cardiovasc Surg 2010; 22: 140-4.
- Carrel T, Englberger L, Mohacsi P, et al. Low systemic vascular resistance after cardiopulmonary bypass: incidence, etiology, and clinical importance. J Card Surg 2000; 15: 347-53.
- Parke RL, McGuinness SP, Gilder E, et al. Intravenous fluid use after cardiac surgery: a multicentre, prospective, observational study. Crit Care Resusc 2014; 16: 164-9.
- Vincent JL, De Backer D. Circulatory shock. N Engl J Med 2013; 369: 1726-34.
- Prowle JR, Kirwan CJ, Bellomo R. Fluid management for the prevention and attenuation of acute kidney injury. Nat Rev Nephrol 2014; 10: 37-47.
- National Heart, Lung and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network; Wiedemann HP, Wheeler AP, Bernard GR, et al. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med 2006; 354: 2564-75.
- Tigabu BM, Davari M, Kebriaeezadeh A, et al. Fluid volume, fluid balance and patient outcome in severe sepsis and septic shock: A systematic review. J Crit Care 2018; 48: 153-9.
- Aronson S, Nisbet P, Bunke M. Fluid resuscitation practices in cardiac surgery patients in the USA: a survey of health care providers. Perioper Med (Lond) 2017; 6: 15.
- Haase N, Perner A, Hennings LI, et al. Hydroxyethyl starch 130/0.38-0.45 versus crystalloid or albumin in patients with sepsis: systematic review with meta-analysis and trial sequential analysis. BMJ 2013; 346: f839.
- Sossdorf M, Marx S, Schaarschmidt B, et al. HES 130/0.4 impairs haemostasis and stimulates pro-inflammatory blood platelet function. Crit Care 2009; 13: R208.
- Moeller C, Fleischmann C, Thomas-Rueddel D, et al. How safe is gelatin? A systematic review and meta-analysis of gelatin-containing plasma expanders vs crystalloids and albumin. J Crit Care 2016; 35: 75-83.
- Sigurjonsson J, Hedman D, Bansch P, et al. Comparison of dextran and albumin on blood coagulation in patients undergoing major gynaecological surgery. Perioper Med (Lond) 2018; 7: 21.
- Martensson J, Bihari S, Bannard-Smith J, et al. Small volume resuscitation with 20% albumin in intensive care: physiological effects: the SWIPE randomised clinical trial. Intensive Care Med 2018; 44: 1797-806.
- Yunos NM, Bellomo R, Hegarty C, et al. Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults. JAMA 2012; 308: 1566-72.
- Wigmore GJ, Anstey JR, St John A, et al. 20% Human Albumin Solution Fluid Bolus Administration Therapy in Patients after Cardiac Surgery (the HAS FLAIR study). J Cardiothorac Vasc Anesth 2019; 33: 2920-7.
- Ferrara A, MacArthur JD, Wright HK, et al. Hypothermia and acidosis worsen coagulopathy in the patient requiring massive transfusion. Am J Surg 1990; 160: 515-8.
- Watts DD, Trask A, Soeken K, et al. Hypothermic coagulopathy in trauma: effect of varying levels of hypothermia on enzyme speed, platelet function, and fibrinolytic activity. J Trauma 1998; 44: 846-54.
- Wall O, Ehrenberg L, Joelsson-Alm E, et al. Haemodynamic effects of cold versus warm fluid bolus in healthy volunteers: a randomised crossover trial. Crit Care Resusc 2018; 20: 277-84.
- Tollofsrud S, Bjerkelund CE, Kongsgaard U, et al. Cold and warm infusion of Ringer’s acetate in healthy volunteers: the effects on haemodynamic parameters, transcapillary fluid balance, diuresis and atrial peptides. Acta Anaesthesiol Scand 1993; 37: 768-73.
- Cutuli SL, Bitker L, Osawa EA, et al. Haemodynamic effect of a 20% albumin fluid bolus in post-cardiac surgery patients. Crit Care Resusc 2020; 22: 15-25.
- Yanase F, Bitker L, Lucchetta L, et al. Comparison of the hemodynamic and temperature effects of a 500-ml bolus of 4% albumin at room versus body temperature in cardiac surgery patients. J Cardiothorac Vasc Anesth 2020; 35: 499-507.
- Taylor MH, Choi D, Fitzpatrick SM, et al. Characterisation of aluminium release by the enFlow(R) fluid-warming system in crystalloids and blood products. Anaesthesia 2019; 74: 1374-80.
- Lee EH, Kim WJ, Kim JY, et al. Effect of exogenous albumin on the incidence of postoperative acute kidney injury in patients undergoing off-pump coronary artery bypass surgery with a preoperative albumin level of less than 4.0 g/dL. Anesthesiology 2016; 124: 1001-11.
- Devlin JW, Skrobik Y, Gelinas C, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med 2018; 46: e825-73.