FLUID BALANCE AND PULMONARY FUNCTIONS DURING AND AFTER CORONARY-ARTERY BYPASS-SURGERY - RINGERS ACETATE COMPARED WITH DEXTRAN, POLYGELINE, OR ALBUMIN

The effects an fluid balance, pulmonary functions and economics were e valuated in a randomized comparison of one colloid free and three coll oid containing fluid regimens, for 48 hours during and after coronary artery bypass (CAB) surgery. A standard regimen for anaesthesia, extra corporeal circulation and monitoring was used. Only Ringer's acetate ( RAc) was used as priming solution for extracorporeal circulation. Fort y patients were randomized to receive either RAc, polygeline 35 mg . m l(-1) (Haemaccel(R)), dextran 70 (Macrodex(R)) 60 mg . ml(-1), or albu min 40 mg . ml(-1) in saline whenever fluid Volume was needed to stabi lize haemodynamics. At the end of the operation, fluid retention was s ignificantly lower in patients receiving polygeline and dextran 70, co mpared with patients receiving RAc. At 48 hours, however, there were n o differences in cumulative fluid balance. Patients in the colloid gro ups postoperatively had a higher serum colloid osmotic pressure (s-COP ), but a higher net lung capillary filtration pressure (Delta P) only on the second postoperative day than the RAc group. However, this did not adversely affect intrapulmonary venous admixture, arterial oxygen tension, or time on respirator in the RAc group compared with the coll oid groups. The most expensive colloid fluid regimen (albumin) cost ab out 230 US$ more per patient than the RAc fluid regimen. We conclude t hat Ringer's acetate for volume replacement to stabilize haemodynamics during and after CAB surgery is associated with increased fluid reten tion only during the intraoperative period, compared with dextran 70 o r polygeline, and with a lower serum colloid osmotic pressure and net lung capillary filtration pressure postoperatively, compared with all three colloid groups. This does not affect pulmonary functions adverse ly. Thus, the RAc regimen is clinically fully acceptable and economica lly more favourable than the polygeline, dextran 70, and albumin-conta ining fluid regimens.