Influence of Volume Replacement with Colloids versus Crystalloids in Neonates on Venoarterial Extracorporeal Membrane Oxygenation on Fluid Retention, Fluid Balance, and ECMO Runtime

Abstract

In this retrospective study, we compared the effects of colloid versus crystalloid fluid replacement on the clinical signs of capillary leakage syndrome in 30 neonates with pulmonary hypertension due to meconium aspiration syndrome on venoarterial membrane oxygenation (VA-ECMO). Before 2000, 15 neonates received volume replacement with a pasteurized plasma protein solution (3.8% albumin); after 2000, 15 neonates received normal saline. Patient characteristics and pre-ECMO values did not differ between the two groups. Total fluid balance was also equal. Diuretic use was significantly higher in the colloid group (p < 0.001). The chest wall soft-tissue index was significantly higher in the crystalloid group (p < 0.005), as were the ventilator settings at the end of the ECMO runtime (p < 0.05). Serum colloid osmotic pressure, albumin, urea nitrogen, and creatinine were significantly higher in the colloid group (p < 0.0001, < 0.0001, < 0.001, and < 0.05, respectively). Duration of VA-ECMO, of artificial ventilation after ECMO treatment, and the mortality rate did not differ between the two groups. We conclude that volume replacement with crystalloids in neonates on VA-ECMO aggravated the edema in a preexisting situation of capillary leakage syndrome, whereas volume replacement with colloids could impair the kidney function.

Physiologically Based Pharmacokinetic Approach to Determine Dosing on Extracorporeal Life Support: Fluconazole in Children on ECMO

“…The ECMO compartment was parameterized using data from our previously published ex vivo study 15. The ECMO model was updated to include edema that is common in patients on ECMO 16, 17. Model predictions in children on ECMO were evaluated using data from our ECMO Fluconazole PK trial 10…”

“…The ECMO PBPK model was exported from MoBi back into PK Sim where the edema disease state was added to the model. Because children on ECMO develop severe edema secondary to capillary leak syndrome, edema was added to the model by scaling the child's body weight by 30%, and assigning the resulting increase in volume to the interstitial space of all organ compartments 16, 17. In addition the interstitial:plasma protein ratio was increased from the default value of 0.37 to 1 to account for equalization of proteins due to capillary leakage 35.…”

“…15 The ECMO model was updated to include edema that is common in patients on ECMO. 16,17 Model predictions in children on ECMO were evaluated using data from our ECMO Fluconazole PK trial. 10…”

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

“…The large meta-analysis could demonstrate no benefit in critically ill patients' outcome with the use of either crystalloid or colloid solutions (Perel and Roberts 2007). Several clinical studies have demonstrated a higher amount of extravascular lung water during use of crystalloids, which can aggravate tissue edema and worsen lung function (Lang et al 2001, Vrancken et al 2005). …”

“…After major surgery, maintenance of an adequate preload requires a volume of crystalloids double or more than that of colloids (Lang et al 2001). Thus, risk for tissue edema and risk for an increased amount of extravascular lung water can rise, as has occurred in critically ill patients (Vrancken et al 2005).…”