Journal Article

Fluid management in patients undergoing cardiac surgery: effects of an acetate- versus lactate-buffered balanced infusion solution on hemodynamic stability (HEMACETAT)

Englberger, Lars, Eberle, Balthasar, Prazak, Josef, Pfortmueller, Carmen A., Müller, Martin, Zante, Björn, Jenni, Hansjörg, Jakob, Stephan M., Takala, Jukka, Faeh, Livia

2019

Overview

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.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Aged / Analysis / Blood / Blood Gas Analysis / Buffers / Cardiac patients / Cardiac surgical procedures / Cardiac Surgical Procedures - methods / Cardiac Surgical Procedures - standards / Clinical trials / Comparative analysis / Critical care / Critical Care Medicine / Crystalloid solutions / Disease / Double-Blind Method / Drug dosages / Emergency Medicine / Female / Flow velocity / Fluid therapy / Fluid Therapy - methods / Fluid Therapy - standards / Fluids / Health aspects / Heart surgery / Heart valve diseases / Hemodialysis / Hemodynamics / Hemodynamics - drug effects / Homeostasis / Humans / Intensive / Intensive care / Isotonic Solutions - adverse effects / Isotonic Solutions - pharmacology / Isotonic Solutions - therapeutic use / Lactates / Linear Models / Liver / Liver diseases / Male / Medical research / Medicine / Medicine & Public Health / Metabolism / Middle Aged / Monitoring, Physiologic - methods / Monitoring, Physiologic - statistics & numerical data / Patients / Randomized controlled trial / Ringer's Lactate - adverse effects / Ringer's Lactate - pharmacology / Ringer's Lactate - therapeutic use / Sepsis / Time Factors / Vasoconstrictor agents