Hypertonic-Hyperoncotic Solutions Improve Cardiac Function in Children after Open Heart Surgery

Objectives: Hypertonic-hyperoncotic solutions (HHS) are used for improvement of micro- and macrocirculation in various types of shock. In paediatric intensive care controlled, randomized studies with HHS are lacking. The aim of this randomized, double-blind study was to evaluate the hemodynamic effects of HHS in children.

Methods and Measurements: 50 children were randomized after open heart surgery. Immediately after arrival on intensive care, HHS (7.2% NaCl, 6% hydroxyethyl-starch) or isotonic saline (ISS) was administered. Cardiac index (CI), stroke volume index (SVI), systemic vascular resistance index (SVRI), extravascular lung water index (ELWI) were measured by transpulmonal thermodilution.

Main Results: CI increased (3.6±0.26 to 5.96±0.27 l/min/m2) after HHS (p<0.001), in the control group CI remained unchanged after ISS (3.4±0.21 to 3.6±0.23 l/min/m2). SVRI decreased significantly after HHS (1396±112 to 868±63 dyn x s x cm-5 x m2, p<0.001), no change occurred after ISS (1741±140 to 1638±109 dyn x s x cm-5 x m2). ELWI decreased from 10.6±1.2 to 5.6±1.2ml/kg (p<0.001) (HHS), an increase from 12.3±1.1 to 18.1±1.7ml/kg (p<0.001) was seen in ISS group. No severe adverse events occurred during or after HHS infusion. Survival did not differ, all patients were dismissed from hospital without any cardiac or neurological problems.

Conclusions: Our data suggest that the administration of HHS leads to an improvement of haemodynamics in paediatric patients after open heart surgery. Furthermore, HHS leads to a reduction in ELWI and might therefore be effective in reducing post-bypass edema.