Effect of Goal-Directed Crystalloid versus Colloid Administration on Perioperative Hemostasis in Partial Hepatectomy: A Randomized, Controlled Trial

Gratz, Johannes; Zotti, Oliver; Pausch, André; Wiegele, Marion; Fleischmann, Edith; Gruenberger, Thomas; Krenn, Claus G.; Kabon, Barbara

doi:10.3390/jcm10081651

Cited by 3 publications

(2 citation statements)

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“…On the other hand, the administration of hydroxyethyl starches still carries the risk of serious side effects such as allergic reactions, dose-dependent incidence of pruritus, increase in serum amylase, and impairment of hemostatic capacity. 4,5 We recently published a large outcome trial, in which we investigated the effect of goal-directed colloid administration…”

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Hemodynamic Responses to Crystalloid and Colloid Fluid Boluses during Noncardiac Surgery

et al. 2021

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Background Colloids are thought to sustain blood pressure and cardiac index better than crystalloids. However, the relative effects of intraoperative hydroxyethyl starch and crystalloid administration on the cardiac index and blood pressure remain unclear. This study therefore tested in this subanalysis of a previously published large randomized trial the hypothesis that intraoperative goal-directed colloid administration increases the cardiac index more than goal-directed crystalloid administration. Further, the effects of crystalloid and colloid boluses on blood pressure were evaluated. Methods This planned subanalysis of a previous trial analyzed data from 973 patients, of whom 480 were randomized to colloids and 493 were randomized to crystalloids. Fluid administration was guided by esophageal Doppler. The primary outcome was the time-weighted average cardiac index during surgery between the colloid and crystalloid group. The secondary outcomes were the cardiac index just after bolus administration, time elapsed between boluses, and the average real variability during surgery. The study recorded cardiac index, corrected flow time, and blood pressure at 10-min intervals, as well as before and after each bolus. Results Time-weighted average of cardiac index over the duration of anesthesia was only slightly greater in patients given colloid than crystalloid, with the difference being just 0.20 l · min–1 · m–2 (95% CI, 0.11 to 0.29; P < 0.001). However, the hazard for needing additional boluses was lower after colloid administration (hazard ratio [95% CI], 0.60 [0.55 to 0.66]; P < 0.001) in a frailty time-to-event model accounting for within-subject correlation. The median [quartiles] number of boluses per patient was 4 [2, 6] for colloids and 6 [3, 8] for crystalloids, with a median difference (95% CI) of –1.5 (–2 to –1; P < 0.001). The average real mean arterial pressure variability did not differ significantly between the groups (difference in means [95% CI] of –0.03 (–0.07 to 0.02) mmHg, P = 0.229). Conclusions There were not clinically meaningful differences in the cardiac index or mean pressure variability in patients given goal-directed colloid and crystalloids. As might be expected from longer intravascular dwell time, the interval between boluses was longer with colloids. However, on a case basis, the number of boluses differed only slightly. Colloids do not appear to provide substantial hemodynamic benefit. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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Hemodynamic Responses to Crystalloid and Colloid Fluid Boluses during Noncardiac Surgery

et al. 2021

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Goal-Directed Therapy in Liver Surgery

Marcus,

Syed,

Anderson

et al. 2024

Curr Anesthesiol Rep

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Purpose of Review This review summarizes the updated literature on goal-directed therapy during liver surgery. It provides guidance for clinicians regarding physiologic concepts and clinical evidence related to fluid and hemodynamic management strategies during and after liver resection. Recent Findings Open liver resection presents unique anatomic and physiologic challenges for the anesthesiologist. Care must be taken to reduce hemorrhage via control of inflow and outflow of hepatic blood. Resuscitation should be individualized to the patient and primarily utilize balanced crystalloids, blood products, and possibly albumin. Administration of intravenous fluids should be guided by hemodynamic parameters. Minimally invasive liver resection may be beneficial to patients but presents additional considerations for goal-directed therapy. Summary Goal-directed therapy can be utilized to decrease blood loss and optimize the surgical field during liver resection. This strategy holds promise to improve patient outcomes after liver surgery.

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Does perioperative fluid management affect the development of postoperative complications in major gastrointestinal tract surgery? A retrospective cohort study

Altintaş¹,

Saraçoğlu²,

Kocaoğlu³

et al. 2022

Journal of Surgery and Medicine

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Background/Aim: In major abdominal surgeries, maintenance of electrolyte homeostasis and euvolemia is crucial. However there is still no consensus on the most effective intraoperative fluid regimen. Our primary aim in this study was to investigate the impact of colloid infusion given in addition to perioperative fluid replacement on the development of postoperative complications in patients undergoing major gastrointestinal tract surgery. Methods: Patients who underwent major abdominal surgery in our hospital due to gastrointestinal tract malignancy between January 2015 and January 2020 were enrolled in this retrospective cohort study. We recorded data regarding the volume of perioperative fluid replacement, the amount of crystalloid and colloid administered, postoperative complications, length of hospital stay, frequency of follow-up in the intensive care unit and length of stay. Results: A total of 326 patients, who underwent gastrointestinal tract surgery, were included in the study. Postoperative pulmonary complications (24.2%), wound infection (20.6%), and anastomotic leakage (3.1%) were the most-observed three complications in the study cohort. Among 163 patients who required postoperative ICU follow-up, 84 (25.7%) patients received colloid infusion, whereas 79 (24.2%) patients did not receive (P=0.181). However, the incidence of other complications in the group with a crystalloid intake of ≤2 L was found to be significantly higher compared to the group receiving >2 L of crystalloids (P=0.038). Conclusion:We found no association between the administration of colloids along with crystalloid infusion and the incidence of postoperative complications. Besides there was no relation with the adverse effects in terms of the length of hospital stay and the frequency of admission to the intensive care unit.

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Effect of Goal-Directed Crystalloid versus Colloid Administration on Perioperative Hemostasis in Partial Hepatectomy: A Randomized, Controlled Trial

Cited by 3 publications

References 42 publications

Hemodynamic Responses to Crystalloid and Colloid Fluid Boluses during Noncardiac Surgery

Hemodynamic Responses to Crystalloid and Colloid Fluid Boluses during Noncardiac Surgery

Goal-Directed Therapy in Liver Surgery

Does perioperative fluid management affect the development of postoperative complications in major gastrointestinal tract surgery? A retrospective cohort study

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