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

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

doi:10.1007/s00134-006-0195-5

Cited by 125 publications

(103 citation statements)

References 37 publications

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“…This study demonstrated that the use of rapidly degradable HES solutions after elective cardiac surgery is an effective method to maintain postoperative hemodynamics, which is in agreement with previous findings (Gallandat Huet et al 2000, Verheij et al 2006a, Kuitunen et al 2007). Many studies demonstrate the effectiveness of rapidly degradable HES solutions, but discussion is continuous about the side-effects of these fluids.…”

Section: Colloids and Crystalloids After Cardiac Surgery: Hemodynamicssupporting

confidence: 92%

“…However, many investigators have shown that colloid solutions improve hemodynamics better than do crystalloids in animal experiments (Su et al 2007), in septic patients (Huang et al 2009), and after cardiac or major vascular surgery (Karanko et al 1987, Verheij et al 2006a. Some studies show body weight gain and extravascular lung water to be increased through the use of crystalloid solutions (Huang et al 2009), and after major surgery, this fluid overload can prolong the ICU stay (Gan et al 2002).…”

Section: Principles Of Volume Replacement Therapy After Major Surgerymentioning

confidence: 99%

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Post‐operative volume therapy in cardiac surgery: effects on hemostatic and circulatory variables

Schramko¹

2011

Acta Anaesthesiol Scand

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Section: Colloids and Crystalloids After Cardiac Surgery: Hemodynamicssupporting

confidence: 92%

Section: Principles Of Volume Replacement Therapy After Major Surgerymentioning

confidence: 99%

Post‐operative volume therapy in cardiac surgery: effects on hemostatic and circulatory variables

Schramko¹

2011

Acta Anaesthesiol Scand

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“…This is a substudy of a prospective, non-randomized, single-center clinical trial, investigating the volume expanding effects of various resuscitation fluids [23]. The study was approved by the Ethics Committee of the Vrije Universiteit Medical Center.…”

Section: Methodsmentioning

confidence: 99%

“…We analyzed the effect of colloid fluid loading in patients who had undergone coronary artery ( n = 18) or major vascular surgery ( n = 14). Colloid fluid loading was given with modified fluid gelatin 4%, hydroxyethyl starch (HES) 6% or albumin 5%, all of which have similar oncotic properties and hemodynamic responses [23]. We only analyzed patients who completed fluid loading and measurements up to t = 90 minutes.…”

Section: Methodsmentioning

confidence: 99%

“…After baseline measurements were taken, fluids were given over 90 minutes on the basis of the response within predefined limits of increases in pressures (CVP or - when available - PAOP), according to a previously described protocol [23,26,27]. Up to 200 mL of fluid were given every 10 minutes, provided that the increase in filling pressures with the fluid loading did not exceed critical values, and this policy has been proven safe in previous studies (that is, not evoking pulmonary edema) [23,26,27]. The maximum amount of fluid infused was 1,800 mL.…”

Section: Methodsmentioning

confidence: 99%

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Cardiac filling volumes versus pressures for predicting fluid responsiveness after cardiovascular surgery: the role of systolic cardiac function

et al. 2011

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IntroductionStatic cardiac filling volumes have been suggested to better predict fluid responsiveness than filling pressures, but this may not apply to hearts with systolic dysfunction and dilatation. We evaluated the relative value of cardiac filling volume and pressures for predicting and monitoring fluid responsiveness, according to systolic cardiac function, estimated by global ejection fraction (GEF, normal 25 to 35%) from transpulmonary thermodilution.MethodsWe studied hypovolemic, mechanically ventilated patients after coronary (n = 18) or major vascular (n = 14) surgery in the intensive care unit. We evaluated 96 colloid fluid loading events (200 to 600 mL given in three consecutive 30-minute intervals, guided by increases in filling pressures), divided into groups of responding events (fluid responsiveness) and non-responding events, in patients with low GEF (<20%) or near-normal GEF (≥20%). Patients were monitored by transpulmonary dilution and central venous (n = 9)/pulmonary artery (n = 23) catheters to obtain cardiac index (CI), global end-diastolic volume index (GEDVI), central venous (CVP) and pulmonary artery occlusion pressure (PAOP).ResultsFluid responsiveness occurred in 8 (≥15% increase in CI) and 17 (≥10% increase in CI) of 36 fluid loading events when GEF was <20%, and 7 (≥15% increase in CI) and 17 (≥10% increase in CI) of 60 fluid loading events when GEF was ≥20%. Whereas a low baseline GEDVI predicted fluid responsiveness particularly when GEF was ≥20% (P = 0.002 or lower), a low PAOP was of predictive value particularly when GEF was <20% (P = 0.004 or lower). The baseline CVP was lower in responding events regardless of GEF. Changes in CVP and PAOP paralleled changes in CI particularly when GEF was <20%, whereas changes in GEDVI paralleled CI regardless of GEF.ConclusionsRegardless of GEF, CVP may be useful for predicting fluid responsiveness in patients after coronary and major vascular surgery provided that positive end-expiratory pressure is low. When GEF is low (<20%), PAOP is more useful than GEDVI for predicting fluid responsiveness, but when GEF is near-normal (≥20%) GEDVI is more useful than PAOP. This favors predicting and monitoring fluid responsiveness by pulmonary artery catheter-derived filling pressures in surgical patients with systolic left ventricular dysfunction and by transpulmonary thermodilution-derived GEDVI when systolic left ventricular function is relatively normal.

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Effect of Hydroxyethyl Starch vs Saline for Volume Replacement Therapy on Death or Postoperative Complications Among High-Risk Patients Undergoing Major Abdominal Surgery

Futier

Garot

Godet

et al. 2020

JAMA

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; for the FLASH Trial Group IMPORTANCE It is not known if use of colloid solutions containing hydroxyethyl starch (HES) to correct for intravascular deficits in high-risk surgical patients is either effective or safe. OBJECTIVE To evaluate the effect of HES 130/0.4 compared with 0.9% saline for intravascular volume expansion on mortality and postoperative complications after major abdominal surgery. DESIGN, SETTING, AND PARTICIPANTS Multicenter, double-blind, parallel-group, randomized clinical trial of 775 adult patients at increased risk of postoperative kidney injury undergoing major abdominal surgery at 20 university hospitals in France from February 2016 to July 2018; final follow-up was in October 2018. INTERVENTIONS Patients were randomized to receive fluid containing either 6% HES 130/0.4 diluted in 0.9% saline (n = 389) or 0.9% saline alone (n = 386) in 250-mL boluses using an individualized hemodynamic algorithm during surgery and for up to 24 hours on the first postoperative day, defined as ending at 7:59 AM the following day. MAIN OUTCOMES AND MEASURES The primary outcome was a composite of death or major postoperative complications at 14 days after surgery. Secondary outcomes included predefined postoperative complications within 14 days after surgery, durations of intensive care unit and hospital stays, and all-cause mortality at postoperative days 28 and 90. RESULTS Among 826 patients enrolled (mean age, 68 [SD, 7] years; 91 women [12%]), 775 (94%) completed the trial. The primary outcome occurred in 139 of 389 patients (36%) in the HES group and 125 of 386 patients (32%) in the saline group (difference, 3.3% [95% CI, −3.3% to 10.0%]; relative risk, 1.10 [95% CI, 0.91-1.34]; P = .33). Among 12 prespecified secondary outcomes reported, 11 showed no significant difference, but a statistically significant difference was found in median volume of study fluid administered on day 1: 1250 mL (interquartile range, 750-2000 mL) in the HES group and 1500 mL (interquartile range, 750-2150 mL) in the saline group (median difference, 250 mL [95% CI, 83-417 mL]; P = .006). At 28 days after surgery, 4.1% and 2.3% of patients had died in the HES and saline groups, respectively (difference, 1.8% [95% CI, −0.7% to 4.3%]; relative risk, 1.76 [95% CI, 0.79-3.94]; P = .17). CONCLUSIONS AND RELEVANCE Among patients at risk of postoperative kidney injury undergoing major abdominal surgery, use of HES for volume replacement therapy compared with 0.9% saline resulted in no significant difference in a composite outcome of death or major postoperative complications within 14 days after surgery. These findings do not support the use of HES for volume replacement therapy in such patients.

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

Cited by 125 publications

References 37 publications

Post‐operative volume therapy in cardiac surgery: effects on hemostatic and circulatory variables

Post‐operative volume therapy in cardiac surgery: effects on hemostatic and circulatory variables

Cardiac filling volumes versus pressures for predicting fluid responsiveness after cardiovascular surgery: the role of systolic cardiac function

Effect of Hydroxyethyl Starch vs Saline for Volume Replacement Therapy on Death or Postoperative Complications Among High-Risk Patients Undergoing Major Abdominal Surgery

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