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].