Fluids after cardiac surgery: a pilot study of the use of colloids versus crystalloids.
OBJECTIVE
To determine whether a starch solution for volume resuscitation in a flow-based protocol improves circulatory status better than a crystalloid solution, as defined by the need for catecholamines in patients the morning after cardiac surgery, and whether this can be performed without increased morbidity.


METHODS
Concealed, randomized, double-blind, controlled trial.


METHODS
Two hundred sixty-two patients who underwent cardiac surgery at a tertiary care hospital.


METHODS
Based on predefined criteria indicating a need for fluids, and a nurse-delivered algorithm that used central venous pressure and cardiac index obtained from a pulmonary artery catheter, patients were allocated to receive 250-mL boluses of 0.9% saline or a 250-molecular weight 10% solution of pentastarch.


RESULTS
Two hundred thirty-seven patients received volume boluses: 119 hydroxyethyl starches and 118 saline. Between 8:00 am and 9:00 am the morning after surgery, 13 (10.9%) of hydroxyethyl starch patients and 34 (28.8%) saline patients were using catecholamines (p = .001). Hydroxyethyl starch patients had less pneumonia and mediastinal infections (p = .03) and less cardiac pacing (p = .03). There were two deaths in each group. There was no difference in the daily creatinine, development of RIFLE risk criteria during hospital stay, or new dialysis. The numbers and volumes of packed red blood cells were similar in the two groups, but more hydroxyethyl starch patients received plasma transfusions (p = .05).


CONCLUSIONS
Use of a colloid solution for volume resuscitation in a nurse-delivered flow-based algorithm, which included a pulmonary artery catheter, significantly improved hemodynamic status, an important factor for readiness for discharge from the intensive care unit.
Magder
Sheldon
S
McGill University, Montreal Quebec, Canada. sheldon.magder@muhc.mcgill.ca
Potter
Brian J
BJ
Varennes
Benoit De
BD
Doucette
Steve
S
Fergusson
Dean
D
D000368:Aged; D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures / Q000379:methods*; D003102:Colloids / Q000627:therapeutic use*; D000077324:Crystalloid Solutions; D004311:Double-Blind Method; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006400:Hematocrit; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use; D007552:Isotonic Solutions / Q000627:therapeutic use*; D007902:Length of Stay; D008297:Male; D010865:Pilot Projects; D011182:Postoperative Care / Q000379:methods*; D015532:Rehydration Solutions / Q000627:therapeutic use*; D017582:Renal Replacement Therapy; D012965:Sodium Chloride / Q000627:therapeutic use; D016896:Treatment Outcome
D003102:Colloids; D000077324:Crystalloid Solutions; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D015532:Rehydration Solutions; D012965:Sodium Chloride