title: Cardiac response is greater for colloid than saline fluid loading after cardiac or vascular surgery.
abstract: 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.
  
  
  METHODS
  A single-centre, single-blinded, randomized clinical trial at the intensive care unit of a university hospital.
  
  
  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.
  
  
  CONCLUSIONS
  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.affiliation: Department of Intensive Care, VU Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
authors.forename: Joanne
authors.initials: J
authors.lastname: Verheij
authors.forename: Arthur
authors.initials: A
authors.lastname: van Lingen
authors.forename: Albertus
authors.initials: A
authors.lastname: Beishuizen
authors.forename: Herman M T
authors.initials: HM
authors.lastname: Christiaans
authors.forename: Jan R
authors.initials: JR
authors.lastname: de Jong
authors.forename: Armand R J
authors.initials: AR
authors.lastname: Girbes
authors.forename: Willem
authors.initials: W
authors.lastname: Wisselink
authors.forename: Jan A
authors.initials: JA
authors.lastname: Rauwerda
authors.forename: Marinus A J M
authors.initials: MA
authors.lastname: Huybregts
authors.forename: A B Johan
authors.initials: AB
authors.lastname: Groeneveld
mesh_terms: D000328:Adult; D000368:Aged; D000418:Albumins / Q000627:therapeutic use; D002302:Cardiac Output; D006348:Cardiac Surgical Procedures; D000077324:Crystalloid Solutions; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D005780:Gelatin / Q000627:therapeutic use; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use; D020896:Hypovolemia / Q000209:etiology / Q000628:therapy*; D007552:Isotonic Solutions / Q000627:therapeutic use; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000627:therapeutic use*; D011446:Prospective Studies; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures
chemical_list: D000418:Albumins; D000077324:Crystalloid Solutions; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D012462:Saline Solution, Hypertonic; D005780:Gelatin