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Large-dose hydroxyethyl starch (HES) 130/0.4 in elective coronary artery bypass surgery

Objective

To test the hypothesis that, in elective coronary artery bypass surgery, HES 130/0.4 at a dose of up to 50 ml/kg does not increase blood loss and transfusion requirements over the levels with HES 200/0.5, 33 ml/kg, plus gelatin.

Patients and methods

One hundred and twenty adult patients were randomized to receive up to 50 ml/kg of 6% HES 130/0.4 (Voluven®; Fresenius Kabi, Bad Homburg, Germany) or up to 33 ml/kg of 6% HES 200/0.5 (Haes-steril®; 6%; Fresenius Kabi) plus gelatin for volume replacement during elective coronary artery bypass surgery and until 24 hours thereafter. The first 33ml/kg of HES 130/0.4 or HES 200/0.5 were administered in a double-blind fashion. Colloids (HES, gelatin) were given at the discretion of the attending physicians. Erythrocyte transfusions were administered per protocol. Outcome variables were (1) chest tube output during the first 24 hours after surgery, and (2) erythrocyte transfusion requirements until postoperative day 7. Data were compared using the Mann–Whitney test. A two-sided P < 0.05 was considered significant.

Results

One hundred and sixteen patients (58 patients from each group) completed the study according to protocol. Four patients (two from each group) required re-exploration for bleeding, which was confined to specific sites with no observation of generalized bleeding. These four patients were excluded from the analysis. The median (interquartile range) dose of HES administered was 49 (5.5) ml/kg and 33 (0) ml/kg in the HES 130/0.4 and HES 200/0.5 groups, respectively (P < 0.0001). The two groups (HES 130/0.4 vs HES 200/0.5) did not differ in postoperative (0–24 hours) chest tube output (635 [365] ml vs 705 [408] ml, P = 0.48), the hematocrit of the drainage fluid (0.17 [0.09] vs 0.18 [0.11], P = 0.53), and erythrocyte transfusion requirements until postoperative day 7 (1 [2] units vs 1 [2] units, P = 0.62).

Conclusion

In elective coronary artery bypass surgery, HES 130/0.4, 49 ml/kg, did not increase chest tube output and erythrocyte transfusion requirements over the levels with HES 200/0.5, 33 ml/kg, plus gelatin.

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Kasper, S., Meinert, P., Görg, C. et al. Large-dose hydroxyethyl starch (HES) 130/0.4 in elective coronary artery bypass surgery. Crit Care 6, P173 (2002). https://doi.org/10.1186/cc1633

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Keywords

  • Starch
  • Blood Loss
  • Gelatin
  • Emergency Medicine
  • Interquartile Range