Fluid Resuscitation after Cardiac surgery: Is Hypertonic Saline or
Hyperoncotic Albumin the Future?
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.