الفهرس 
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Abstract
Fluid bolus therapy (FBT) is common for the optimization of cardiac output and the treatment of hypotension after cardiac surgery.
Colloid solutions have been widely used for FBT as they are thought to provide a more sustained physiological response than a similar volume of crystalloid FBT, which may result in smaller volumes of resuscitation fluid being delivered.
The aim of this study was to compare the effects of fluid bolus therapy using 20% albumin versus crystalloid on fluid balance, hemodynamic parameters, and intensive care unit (ICU) treatment effects in post–cardiac surgery patients.
This was a Sequential period double blinded study that was conducted at Department of Critical Care Medicine, Ain Shams University Hospital over 6 months on post-cardiac surgery mechanically ventilated patients with a clinical decision to administer fluid bolus therapy.
The first 25 patients were treated with crystalloid fluid bolus therapy in the first period (control), and 25 patients with up to 2 treatments of 100 mL of 20% albumin fluid bolus therapy in the second period (intervention), followed by crystalloid therapy if needed.
Statistical analysis revealed the following:
1- There was no statistically significant difference between two groups regarding Age, Sex, BMI, Smoking, HTN, Diabetes, Congestive cardiac failure, Peripheral vascular disease and musculoskeletal disease.
2- There was no statistically significant difference between two groups regarding Serum creatinine (mg/dL), Serum Albumin (g/dL), Operation type, Admission type, and there was statistically significant difference found between two groups regarding APACHE III score.
3- There was statistically significant difference found between two groups regarding Net fluid positive balance at 24 h post-op (mL), Total volume of resus fluid in first 24 h, discrete number of fluid bolus (es) in the first 24 h and total volume of fluid in first 24 h.
4- There was no statistically significant difference between two groups regarding delta serum chloride at 24 h post-op (mmol/L) and renal replacement therapy post-operatively in ICU, and there was statistically significant difference found between two groups regarding ICU, and Hospital stay, duration of mechanical ventilation, total dose nor epinephrine/kg in the first 24h post-op( microg/kg), time to cessation of nor epinephrine infusion (h) and Delta serum creatinine at 24 h post-op (mg/dl).
5- There was no statistically significant difference between two groups regarding discharge status from hospital.
In conclusion, in patients admitted to ICU following cardiac surgery, FBT with 20% albumin, when compared to crystalloid FBT, achieved equivalent cardiovascular optimization with smaller volumes of resuscitation fluid, less positive cumulative balance, and without evidence of any negative sequelae. Moreover, the use of 20% albumin for FBT was associated with lower amounts of vasopressor being delivered, shorter duration of vasopressor therapy.
CONCLUSION
In conclusion, in patients admitted to ICU following cardiac surgery, FBT with 20% albumin, when compared to crystalloid FBT, achieved equivalent cardiovascular optimization with smaller volumes of resuscitation fluid, less positive cumulative balance, and without evidence of any negative sequelae. Moreover, the use of 20% albumin for FBT was associated with lower amounts of vasopressor being delivered and shorter duration.
RECOMMENDATIONS
Further studies are recommended for supporting these findings and to widen usage of 20% albumin over crystalloid FBT after cardiac surgeries for better outcome.