Journal Article

Cardiac response is greater for colloid than saline fluid loading after cardiac or vascular surgery

Beishuizen, Albertus, Groeneveld, A. B. Johan, Christiaans, Herman M. T., van Lingen, Arthur, de Jong, Jan R., Verheij, Joanne, Rauwerda, Jan A., Huybregts, Marinus A. J. M., Girbes, Armand R. J., Wisselink, Willem

2006

Overview

To study the effects on volume expansion and myocardial function of colloids or crystalloids in the treatment of hypovolaemic hypotension after cardiac and major vascular surgery. A single-centre, single-blinded, randomized clinical trial at the intensive care unit of a university hospital. Patients (n=67) were subjected to a 90-min filling pressure-guided fluid challenge with saline 0.9% or the colloids gelatin 4%, hydroxyethyl starch 6% or albumin 5%. Biochemical variables and haemodynamics (transpulmonary thermodilution) were measured. An amount of 1800 (1300-1800) ml of saline or 1600 (750-1800) ml of colloid solution (P< 0.005) was infused. Colloid osmotic pressure (COP) decreased in the saline group and increased in the colloid groups (P< 0.001). Plasma volume increased by 3.0% (-18 to 24) in the saline versus 19% (-11 to 50) in the colloid groups (P< 0.001). Cardiac index increased by median 13% (ns) in the saline group and by 22% in the colloid groups (P<0.005). The rise in left ventricular stroke work index was greater in the colloid than in the saline groups. The different colloids were equally effective. The rise in cardiac index related to the rise in plasma volume and global end-diastolic volume, confirming plasma volume and preload augmentation by the fluid loading. After cardiac or major vascular surgery, the pressure- and time-guided fluid response is dependent on the type of fluid used. Colloid fluid loading leads to a greater increase in preload-recruitable cardiac and left ventricular stroke work indices than that with saline, because of greater plasma volume expansion following an increase in plasma COP.

• Publisher: Springer,Springer Nature B.V
• Subject: Adult / Aged / Albumins - therapeutic use / Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy / Biological and medical sciences / Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis / Cardiac function / Cardiac Output / Cardiac Surgical Procedures / Cardiovascular system / Colloids in medicine / Comparative analysis / Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care / Female / Fluid Therapy - methods / Gelatin - therapeutic use / Health aspects / Humans / Hydroxyethyl Starch Derivatives - therapeutic use / Hypotension / Hypovolemia - etiology / Hypovolemia - therapy / Intensive care / Intensive care medicine / Isotonic Solutions - therapeutic use / Linear Models / Male / Medical sciences / Middle Aged / Physiologic salines / Plasma / Plasma Substitutes - therapeutic use / Prospective Studies / Saline Solution, Hypertonic - therapeutic use / Stroke / Surgery / Transfusions. Complications. Transfusion reactions. Cell and gene therapy / Treatment Outcome / Vascular surgery / Vascular Surgical Procedures