The use of crystalloids following cardiac surgery
In a multicenter observational study by Park, et al., researchers showed
that cardiac patients often receive 4-5L of fluid in the first 24 hours
in the ICU post-operatively [71], with crystalloids being the most
commonly used solution [13, 71]. Crystalloids are utilized due to
its low-cost, ease of use, and multiple studies showing no significant
evidence of improved outcomes when administered albumin over
crystalloid[38, 49, 52, 72]. In comparison to colloids, multiple
studies indicate that more crystalloid fluid administration is needed to
create similar changes in hemodynamic goals [49, 52, 62].
For post-operative cardiac patients, increase fluid administration can
be associated with acute renal dysfunction, increased length of stay in
the ICU, and mortality [16, 73]. Stein, et al. found a moderate
association between length of ICU stay and fluid overload (r=0.57,P <0.001)[16]. They observed that 10% fluid
overload had a significant and independent effect on combined events
including death, infection, arrhythmia, bleeding and pulmonary edema (OR
4.43; CI 2.08 to 9.14; P <0.001)[16].