Cardiac response is greater for colloid than saline fluid loading after cardiac or vascular surgery.
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.
Verheij
Joanne
J
Department of Intensive Care, VU Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
van Lingen
Arthur
A
Beishuizen
Albertus
A
Christiaans
Herman M T
HM
de Jong
Jan R
JR
Girbes
Armand R J
AR
Wisselink
Willem
W
Rauwerda
Jan A
JA
Huybregts
Marinus A J M
MA
Groeneveld
A B Johan
AB
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
D000418:Albumins; D000077324:Crystalloid Solutions; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D012462:Saline Solution, Hypertonic; D005780:Gelatin