Greater cardiac response of colloid than saline fluid loading in septic and non-septic critically ill patients with clinical hypovolaemia.
OBJECTIVE
The haemodynamics of crystalloid and colloid fluid loading may depend on underlying disease, i.e. sepsis versus non-sepsis.


METHODS
A single-centre, single-blinded, randomized clinical trial was carried out on 24 critically ill sepsis and 24 non-sepsis patients with clinical hypovolaemia, assigned to loading with normal saline, gelatin 4%, hydroxyethyl starch 6% or albumin 5% in a 90-min (delta) central venous pressure (CVP)-guided fluid loading protocol. Transpulmonary thermodilution was done each 30 min, yielding, among others, global end-diastolic volume and cardiac indices (GEDVI, CI).


RESULTS
Sepsis patients had hyperdynamic hypotension in spite of myocardial depression and dilatation, and greater inotropic/vasopressor requirements than non-sepsis patients. Independent of underlying disease, CVP and GEDVI increased more after colloid than saline loading (P < 0.018), so that CI increased by about 2% after saline and 12% after colloid loading (P = 0.029). The increase in preload-recruitable stroke work was also greater with colloids and did not differ among conditions.


CONCLUSIONS
Fluid loading with colloids results in a greater linear increase in cardiac filling, output and stroke work than does saline loading, in both septic and non-septic clinical hypovolaemia, in spite of myocardial depression and presumably increased vasopermeability potentially decreasing the effects of colloid fluid loading in the former.
Trof
Ronald J
RJ
Department of Intensive Care, Medical Spectrum Twente, Haaksbergerstraat 55, 7513 ER, Enschede, The Netherlands.
Sukul
Sharwan P
SP
Twisk
Jos W R
JW
Girbes
Armand R J
AR
Groeneveld
A B Johan
AB
D018806:APACHE; D000328:Adult; D000368:Aged; D000418:Albumins / Q000627:therapeutic use; D002302:Cardiac Output; D016009:Chi-Square Distribution; D016638:Critical Illness; 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* / Q000503:physiopathology / Q000628:therapy*; D007552:Isotonic Solutions / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000627:therapeutic use*; D011446:Prospective Studies; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use; D018805:Sepsis / Q000150:complications* / Q000503:physiopathology; D016037:Single-Blind Method; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D000418:Albumins; D000077324:Crystalloid Solutions; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D012462:Saline Solution, Hypertonic; D005780:Gelatin