Details

Autor(en) / Beteiligte

• Reddy, Sumeet K., MBChB, PhD, MBA
• Bailey, Michael J., PhD
• Beasley, Richard W., DSc
• Bellomo, Rinaldo, FCICM
• Mackle, Diane M., MN
• Psirides, Alex J., FCICM
• Young, Paul J., FCICM

Titel

Effect of 0.9% Saline or Plasma-Lyte 148 as Crystalloid Fluid Therapy in the Intensive Care Unit on Blood Product Use and Postoperative Bleeding after Cardiac Surgery

Ist Teil von

• Journal of cardiothoracic and vascular anesthesia, 2017-10, Vol.31 (5), p.1630-1638

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2017

Quelle

MEDLINE

Beschreibungen/Notizen

• Objective To evaluate the effect of Plasma-Lyte® 148 (PL-148) compared with 0.9% saline (saline) on blood product use and postoperative bleeding in patients admitted to the intensive care unit (ICU) following cardiac surgery. Design A post-hoc subgroup analysis conducted within a multicenter, double-blind, cluster-randomized, double-crossover study (study 1) and a prospective, single-center nested-cohort study (study 2). Setting Tertiary care hospitals. Participants Adults admitted to ICU after cardiac surgery requiring crystalloid fluid therapy as part of the 0.9% Saline vs. PL-148 for ICU fluid Therapy (SPLIT) trial. Interventions Blinded saline or PL-148 for four alternating seven-week blocks. Measurements and Main Results 954 patients were included in study 1, 475 patients received PL-148 and 479 received saline. 128 of 475 patients (26.9%) in the PL-148 group received blood or a blood product compared with 94 of 479 patients (19.6%) in the saline group (OR [95% CI], 1.51 [1.11-2.05]; P=0.008). In study 2, 131 patients were allocated to PL-148 and 120 patients were allocated to saline. There were no differences between groups in chest drain output from the time of arrival in ICU until 12 hours postoperatively (geometric mean, 566mL for the PL-148 group vs. 547mL in the saline group, P=0.60). Conclusions Our findings do not support the hypothesis that using PL-148 for fluid therapy in ICU following cardiac surgery reduces transfusion requirements compared to saline. The significantly increased proportion of patients receiving blood or blood product with allocation to PL-148 compared to saline was unexpected and requires verification through further research.