Influence of volume replacement with colloids versus crystalloids in neonates on venoarterial extracorporeal membrane oxygenation on fluid retention, fluid balance, and ECMO runtime.
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.
Vrancken
Sabine L
SL
Department of Paediatrics, Division of Neonatology, Radboud University Medical Centre, Nijmegen, the Netherlands. s.vrancken@cukz.umcn.nl
Heijst
Arno Fvan
AF
Zegers
Miranda
M
der Staak
Frans Hvan
FH
Liem
K Djien
KD
van Heijst
Arno F
AF
van der Staak
Frans H
FH
D019559:Capillary Leak Syndrome / Q000209:etiology / Q000628:therapy; D003102:Colloids; D003460:Crystallization; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology / Q000628:therapy; D007231:Infant, Newborn; D008297:Male; D008471:Meconium Aspiration Syndrome / Q000628:therapy; D012189:Retrospective Studies; D013997:Time Factors; D014882:Water-Electrolyte Balance
D003102:Colloids