Original Article
Comparison of the Hemodynamic and Temperature Effects of a 500-mL Bolus of 4% Albumin at Room Versus Body Temperature in Cardiac Surgery Patients

https://doi.org/10.1053/j.jvca.2020.06.045Get rights and content

Objective

To compare the hemodynamic effect of room temperature (cold) 4% albumin fluid bolus therapy (FBT) with body temperature (warm) albumin FBT.

Design

Prospective, before-after trial.

Setting

A tertiary intensive care unit (ICU).

Participants

Sixty ventilated, post-cardiac surgery patients prescribed with 4% albumin FBT.

Intervention

Cold or warm 4% albumin 500 ml FBT.

Measurements and Main Results

We recorded hemodynamic parameters before and for 30 minutes after FBT. Cardiac index (CI) and mean arterial pressure (MAP) responses were defined by a CI increase >15% and a MAP increase >10%, respectively. Immediately after FBT, median [interquartile range] core temperature changed by -0.3 [-0.4; -0.3] °C with cold albumin vs. 0.0 [0.0; 0.1]°C with warm albumin (P<0.001). The median CI increase was 0.3 [0.0; 0.5] L/min/m2 with 14 CI-responders (47%) in both groups (P>0.99). The median immediate MAP increase was 9 [3; 15] mmHg with cold albumin vs. 11 [5; 13] mmHg with warm albumin (P=0.79), with a MAP-response in 16 vs. 17 patients (P=0.99). There was an interaction between group and time for MAP (P=0.002), mean pulmonary artery pressure (PAP) (P=0.002) and core temperature (P<0.001). In the cold albumin group, after the initial response, MAP and mean PAP decreased more slowly than with warm albumin and, after the initial fall, core temperature increased toward baseline.

Conclusion

In postoperative cardiac surgery patients, warm albumin FBT prevents the decrease in core temperature and, after an initial similar increase, is associated with a faster return of MAP and mean PAP toward baseline.

Section snippets

Methods

This study was approved by the ethics committee in Austin Hospital in Melbourne, Australia (reference number LNR/16/Austin/358). The need for informed consent was waived because of the observational nature of the study.

Patients Characteristics

Of the 108 eligible patients, 60 patients without hemodynamic major confounders (30 in each group) were analyzed, and 48 patients were excluded mainly because of changes in norepinephrine dose or sedative drugs (Supplementary Fig 1).

The characteristics of the study patients at baseline were well balanced and are shown in Table 1. More than half of the surgeries were on-pump coronary artery bypass graft, and the median duration of cardio-pulmonary bypass time was similar between the 2 groups.

Key Findings

The authors performed a prospective before-and-after study comparing the hemodynamic and temperature effects of a room temperature (cold) or body temperature (warm) 500-mL bolus of 4% albumin in postoperative cardiac surgery patients using second-to-second measurements. They observed that almost half of the patients in each group achieved an immediate CI-R, with fewer than one-third of these immediate CI-responders showing effect dissipation after 30 minutes. However, the main reason for FBT

Conclusion

In conclusion, cold- albumin FBT immediately lowers core temperature by 0.3°C compared with warm albumin, and the effect continues for up to 30 minutes. Such effect is associated with no differences in CI responsiveness but is associated with significantly different patterns of MAP and mean PAP changes. Furthermore, although these effects are of limited magnitude and probably of limited clinical relevance, they suggest that in hypothermic patients, the administration of warm albumin may be more

Conflict of Interest

F.Y. received a scholarship for a PhD course at Monash University from Japan Student Services Organization and Endeavour scholarship. The funding agencies had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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    However, when the patient met minor confounders (Supplementary appendix 2), recording continued and the patient was included for analysis. Based previous studies, we estimated the standard deviation (SD) for CI and MAP at 0.65 and 10, respectively.10 We thus estimated that this study would have an 80% power (two sided pvalue of 0.05) to detect differences between the two groups equivalent to 63% of the standard deviation (equivalent to a 6.3 mmHg overall MAP difference and a 0.41 L/min/m2 overall CI difference) if 40 patients were recruited in each group.

This research did not receive any specific grant from funding agencies in the public, commercial, or non-for-profit sectors.

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