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Fluid Resuscitation after Cardiac surgery: Is Hypertonic Saline or Hyperoncotic Albumin the Future?
  • Tiffany Otero,
  • Oscar Aljure,
  • Soojie Yu
Tiffany Otero
Banner University Medical Center Tuscon
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Oscar Aljure
University of Miami School of Medicine
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Soojie Yu
Banner University Medical Center Tuscon
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Abstract

Background: Over-resuscitation in post-cardiac patients is associated with significant morbidity and mortality. Accordingly, there is a growing interest in concentrated human albumin and hypertonic saline for resuscitation in cardiac patients following revascularization surgery. In this article, we will review the use of hyperosmolar fluid therapies for resuscitation in post-cardiac surgical patients from the current literature. Methods: A literature search was conducted in MEDLINE (PubMed) utilizing keywords, narrowing publications to 2010-2019. Results: Patients receiving concentrated albumin after cardiac surgery required less fluid bolus therapy, less time on vasopressors and were found to have a less positive fluid balance compared to patients receiving crystalloids. The impact on cardiac output and mean arterial pressure in those given concentrated albumin compared to crystalloid boluses was inconsistent. There was no difference in mortality in those given 20% albumin compared to crystalloids post-revascularization. Hypertonic saline showed some positive immunomodulatory effects in patients post-revascularization. Studies identifying the impact of hypertonic saline on fluid balance and mortality compared to normal saline in patients following revascularization surgery are on-going. Conclusions: In this analysis, publications on resuscitation with hyperoncotic albumin and hypertonic saline in patients post-revascularization surgery were reviewed. While there is data in support of using these alternative fluid therapies in other critically ill patient populations, the limited literature in support of using concentrated albumin and hypertonic saline for resuscitation in following cardiac surgery is equivocal.

Peer review status:UNDER REVIEW

19 Jun 2020Submitted to Journal of Cardiac Surgery
19 Jun 2020Submission Checks Completed
19 Jun 2020Assigned to Editor
21 Jun 2020Reviewer(s) Assigned
01 Jul 2020Review(s) Completed, Editorial Evaluation Pending
13 Jul 2020Editorial Decision: Revise Major
12 Aug 20201st Revision Received
14 Aug 2020Submission Checks Completed
14 Aug 2020Assigned to Editor
14 Aug 2020Reviewer(s) Assigned
31 Aug 2020Review(s) Completed, Editorial Evaluation Pending