Comparison of colloid and crystalloid using goal-directed fluid therapy protocol in non-cardiac surgery: a meta-analysis of randomized controlled trials

et al. 2022

Preprint

Background: To investigate the effect of intraoperative goal-directed fluid therapy (GDFT) combined with enhanced recovery after surgery (ERAS) program on postoperative complications in elderly patients undergoing thoracoscopic pulmonary resection. Methods: Patients, more than 60-year-old, undergoing thoracoscopic pulmonary resection for non small cell lung cancer were randomly divided into GDFT group and restrictive fluid therapy (RFT) group. ERAS program was implemented in all patients. In GDFT group, the intraoperative fluid management was guided by stroke volume variation (SVV), cardiac index (CI) and mean arterial pressure (MAP), maintained the SVV<13%, CI>2.5L/min/m2, and MAP>65 mmHg. In RFT group, fluid maintenance with 2 ml/kg/h of balanced crystalloid solution, norepinephrine was used to maintain MAP>65 mmHg. The incidence of postoperative acute kidney injury (AKI), pulmonary and cardiac complications were compared. Results: 276 patients were enrolled and randomly divided into two groups (138 in each group). Compared to RFT group, the total intraoperative infusion volume, colloids infusion volume, and urine output were larger, the dosage of norepinephrine was lower in GDFT group. Although there were no significant differences of postoperative AKI (GDFT vs RFT; 4.3% vs 8%; P=0.317) and composite postoperative complications (GDFT vs RFT; 66 vs 70) between groups, but the postoperative increase degree of serum creatinine was lower in GDFT group than that in RFT group (GDFT vs RFT; 91.9±25.2 μmol/L vs 97.1±17.6 μmol/L; P=0.048). Conclusions: Compared to ERAS program with RFT, ERAS program with GDFT has slight beneficial effect on postoperative renal function in elderly patients undergoing thoracoscopic pulmonary resection. Trial registration: Registered at ClinicalTrials.gov, NCT04302467 on 26 February 2020.

Section: Discussionmentioning

confidence: 99%

The effect of intraoperative goal-directed fluid therapy combined with enhanced recovery after surgery program on postoperative complications in elderly patients undergoing thoracoscopic pulmonary resection: a prospective randomized controlled study

et al. 2022

Preprint

“…Both colloids and crystalloids can be used in GDFT protocol. Meta-analysis showed that postoperative kidney dysfunction was similar between colloid-based GDFT and crystalloid-based GDFT after major noncardiac surgery (Tyagi et al 2020 ). In our study, HES was used for fluid bolus in GDFT protocol.…”

Section: Discussionmentioning

confidence: 99%

The effect of intraoperative goal-directed fluid therapy combined with enhanced recovery after surgery program on postoperative complications in elderly patients undergoing thoracoscopic pulmonary resection: a prospective randomized controlled study

et al. 2023

Perioper Med

Background To investigate the effect of intraoperative goal-directed fluid therapy (GDFT) combined with enhanced recovery after surgery (ERAS) program on postoperative complications in elderly patients undergoing thoracoscopic pulmonary resection. Methods Patients, more than 60 years old, undergoing thoracoscopic pulmonary resection for non-small cell lung cancer were randomly divided into GDFT group and restrictive fluid therapy (RFT) group. ERAS program was implemented in all patients. In GDFT group, the intraoperative fluid management was guided by stroke volume variation (SVV), cardiac index (CI), and mean arterial pressure (MAP) and maintained the SVV < 13%, CI > 2.5 L/min/m2, and MAP > 65 mmHg. In RFT group, fluid maintenance with 2 ml/kg/h of balanced crystalloid solution, norepinephrine was used to maintain MAP > 65 mmHg. The incidence of postoperative acute kidney injury (AKI) and pulmonary and cardiac complications was compared. Results Two-hundred seventy-six patients were enrolled and randomly divided into two groups (138 in each group). Compared to RFT group, the total intraoperative infusion volume, colloids infusion volume, and urine output were more; the dosage of norepinephrine was lower in GDFT group. Although there were no significant differences of postoperative AKI (GDFT vs RFT; 4.3% vs 8%; P = 0.317) and composite postoperative complications (GDFT vs RFT; 66 vs 70) between groups, but the postoperative increase degree of serum creatinine was lower in GDFT group than that in RFT group (GDFT vs RFT; 91.9 ± 25.2 μmol/L vs 97.1 ± 17.6 μmol/L; P = 0.048). Conclusions Under ERAS program, there was no significant difference of AKI incidence between GDFT and RFT in elderly patients undergoing thoracoscopic pulmonary resection. But postoperative increase degree of serum creatinine was lower in GDFT group. Trial registration Registered at ClinicalTrials.gov, NCT04302467 on 26 February 2020.

“…Hill et al (19) and Martin et al (20) found that albumin administration increased the risk of pulmonary edema. Compared with crystalloids, most studies have shown that albumin has no effect on the outcome in critically ill patients (5,21) and has no effect on pulmonary edema (22), and many studies have been carried out to further investigate the therapeutic effect of albumin. Indeed, comparisons of albumin and crystals have been studied in critically ill patients (23), sepsis (7), septic shock (24), non-cardiac surgery (21), hemorrhagic shock (25), and stroke (20).…”

Section: Discussionmentioning

confidence: 99%

“…Compared with crystalloids, most studies have shown that albumin has no effect on the outcome in critically ill patients (5,21) and has no effect on pulmonary edema (22), and many studies have been carried out to further investigate the therapeutic effect of albumin. Indeed, comparisons of albumin and crystals have been studied in critically ill patients (23), sepsis (7), septic shock (24), non-cardiac surgery (21), hemorrhagic shock (25), and stroke (20). Nevertheless, some studies have shown that albumin can help to improve outcomes (24) and reduce multiple organ failure (26).…”

Section: Discussionmentioning

confidence: 99%

Early Combination of Albumin With Crystalloid Administration Might Reduce Mortality in Patients With Cardiogenic Shock: An Over 10-Year Intensive Care Survey

Zou

Front. Cardiovasc. Med.

Peng

et al. 2022

BackgroundIn updated international guidelines, combined albumin resuscitation is recommended for septic shock patients who receive large volumes of crystalloids, but minimal data exist on albumin use and the optimal timing in those with cardiogenic shock (CS). The objective of this study was to evaluate the relationship between resuscitation with a combination of albumin within 24 h and 30-day mortality in CS patients.MethodsWe screened patients with CS from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Multivariable Cox proportional hazards models and propensity score matching (PSM) were employed to explore associations between combined albumin resuscitation within 24 h and 30-day mortality in CS. Models adjusted for CS considered potential confounders. E-value analysis suggested for unmeasured confounding.ResultsWe categorized 1,332 and 254 patients into crystalloid-only and early albumin combination groups, respectively. Patients who received the albumin combination had decreased 30-day and 60-day mortality (21.7 vs. 32.4% and 25.2 vs. 34.2%, respectively, P < 0.001), and the results were robust after PSM (21.3 vs. 44.7% and 24.9 vs. 47.0%, respectively, P < 0.001) and following E-value. Stratified analysis showed that only ≥ 60 years old patients benefited from administration early albumin. In the early albumin combination group, the hazard ratios (HRs) of different adjusted covariates remained significant (HRs of 0.45–0.64, P < 0.05). Subgroup analysis showed that resuscitation with combination albumin was significantly associated with reduced 30-day mortality in patients with maximum sequential organ failure assessment score≥10, with acute myocardial infarction, without an Impella or intra-aortic balloon pump, and with or without furosemide and mechanical ventilation (HRs of 0.49, 0.58, 0.65, 0.40, 0.65 and 0.48, respectively; P < 0.001).ConclusionThis study found, compared with those given crystalloid-only, resuscitation with combination albumin within 24 h is associated with lower 30-day mortality of CS patients aged≥60. The results should be conducted to further assess in randomized controlled trials.