activated once blood contacts the pump . Concerning cardiac function issue , often only minimal fluid resuscitation is needed to prevent fluid overload . Albumin is superior to artificial colloids . Studies comparing albumin with HES / gelatin have shown that the latter increases postoperative bleeding . HES 200 / 0.5 , HES 130 / 0.4 compromised coagulation function as whereas 4 % albumin had no effect . 5 The meta-analysis by Navickis et al 2 analysed seven studies that compared HES with albumin and found that haemodynamics of the two groups were similar . Albumin reduced the amount of blood loss 6 and blood transfusion required , reduced the need for secondary thoracotomy , with a higher platelet count ( platelet preservation effect ).
Human albumin is able to better maintain blood volume because it exerts a protective effect through strong interaction with the endothelial polysaccharide protein complex ( glycocalyx ) of the vascular walls . 7 The diluted physiological plasma albumin concentration is about 4g / 100ml whereas that for the artificial colloid is only 0.5g / 100ml , thereby conferring a lesser protective effect and poorer maintenance of the physiological status of the blood vessels .
Albumin leads to better osmotic pressure , prevents platelet adhesion , and may lead to less consumption of coagulation factors . For patients with haemorrhage and renal insufficiency , albumin is more suitable as it has minimal side effects . Even so , high-quality randomised controlled studies are needed for cardiac surgery .
Hypoalbuminaemia is a perioperative predictive factor for poor prognosis in cardiac surgery . Infusion of albumin increased survival after surgery . Russell ’ s meta-analysis showed that albumin priming was used for extracorporeal circulation to better maintain colloid osmotic pressure , improve oedema , avoid fluid overload , and reduce platelet consumption . 8 During the follow-up of 19,578 patients with coronary artery bypass grafting , 9 albumin infusion reduced the mortality rate ( 2.47 % in albumin group vs . 3.03 % in the crystalloid group ). Therefore , the advantages of albumin , the natural colloid , make it the first choice for fluid resuscitation after cardiac surgery . During the postoperative resuscitation period , albumin has better resuscitation effect than saline . It reduces the incidence of bleeding after extracorporeal circulation , reduces coagulation factor consumption compared to artificial colloid while having better kidney protection effect and anti-inflammatory effect .
Normal saline or balanced fluid ? Balanced solutions include Ringer ’ s lactate solution and Ringer ’ s acetate solution . Normal saline ( 0.9 % sodium chloride ) is actually not a physiological concentration . Compared with extracellular fluids , normal saline is high in sodium and high in chlorine , which tends to induce hyperchloremic acidosis , which is associated with acute kidney injury ( AKI ). Balanced fluid ( Lactated Ringer ’ s
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