Document Detail


Cardiac response is greater for colloid than saline fluid loading after cardiac or vascular surgery.
MedLine Citation:
PMID:  16791665     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: 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. DESIGN AND SETTING: A single-centre, single-blinded, randomized clinical trial at the intensive care unit of a university hospital. PATIENTS AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.
Authors:
Joanne Verheij; Arthur van Lingen; Albertus Beishuizen; Herman M T Christiaans; Jan R de Jong; Armand R J Girbes; Willem Wisselink; Jan A Rauwerda; Marinus A J M Huybregts; A B Johan Groeneveld
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2006-05-23
Journal Detail:
Title:  Intensive care medicine     Volume:  32     ISSN:  0342-4642     ISO Abbreviation:  Intensive Care Med     Publication Date:  2006 Jul 
Date Detail:
Created Date:  2006-06-22     Completed Date:  2007-02-08     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704851     Medline TA:  Intensive Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1030-8     Citation Subset:  IM    
Affiliation:
Department of Intensive Care, VU Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Albumins / therapeutic use
Cardiac Output
Cardiac Surgical Procedures*
Female
Fluid Therapy / methods*
Gelatin / therapeutic use
Hetastarch / therapeutic use
Humans
Hypovolemia / etiology,  therapy*
Isotonic Solutions / therapeutic use
Linear Models
Male
Middle Aged
Plasma Substitutes / therapeutic use*
Prospective Studies
Saline Solution, Hypertonic / therapeutic use
Treatment Outcome
Vascular Surgical Procedures*
Chemical
Reg. No./Substance:
0/Albumins; 0/Isotonic Solutions; 0/Plasma Substitutes; 0/Saline Solution, Hypertonic; 0/crystalloid solutions; 9000-70-8/Gelatin; 9005-27-0/Hetastarch

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