title: Balanced crystalloid compared with balanced colloid solution using a goal-directed haemodynamic algorithm.
abstract: BACKGROUND
  Controversy exists regarding the optimal i.v. fluids for use with a goal-directed haemodynamic algorithm.
  
  
  METHODS
  In a double-blind pilot study, we randomly assigned 50 patients with primary ovarian cancer undergoing cytoreductive surgery to receive either balanced crystalloid or balanced starch (HES, 130/0.4, 6%) solutions up to the dose limit (50 ml kg(-1)). Fluids were administered to optimize stroke volume measured by oesophageal Doppler within a goal-directed haemodynamic algorithm.
  
  
  RESULTS
  Baseline subject characteristics were similar in both groups. The balanced HES solution maintained stroke volume (P=0.012) better with administration of less fluid. Subjects in the colloid group reached the dose limits of the study medication less frequently (92% vs 62%, P=0.036) and later (2:26 vs 3:33 h, P=0.006) and also required less transfusion of fresh-frozen plasma units (6.0 vs 3.5 units, P=0.035) compared with the crystalloid group. Intra- and postoperative urine output and perioperative plasma levels of creatinine and neutrophil gelatinase-associated lipocalin as renal injury marker were similar in both groups. No differences in the length of intensive care unit and hospital stay were found.
  
  
  CONCLUSIONS
  Using a goal-directed haemodynamic algorithm to optimize stroke volume, a balanced HES solution is associated with better haemodynamic stability and reduced need for fresh-frozen plasma. There were no signs of renal impairment by colloid solutions when fluid administration is targeted to optimize cardiac preload.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, European Competence Center for Ovarian Cancer, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Feldheiser
authors.forename: V
authors.initials: V
authors.lastname: Pavlova
authors.forename: T
authors.initials: T
authors.lastname: Bonomo
authors.forename: A
authors.initials: A
authors.lastname: Jones
authors.forename: C
authors.initials: C
authors.lastname: Fotopoulou
authors.forename: J
authors.initials: J
authors.lastname: Sehouli
authors.forename: K-D
authors.initials: KD
authors.lastname: Wernecke
authors.forename: C
authors.initials: C
authors.lastname: Spies
mesh_terms: D000465:Algorithms; D001794:Blood Pressure / Q000187:drug effects / Q000502:physiology; D002316:Cardiotonic Agents / Q000627:therapeutic use; D000077324:Crystalloid Solutions; D004311:Double-Blind Method; D023381:Endpoint Determination; D005440:Fluid Therapy; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use*; D007432:Intraoperative Period; D007552:Isotonic Solutions / Q000627:therapeutic use*; D007902:Length of Stay; D018579:Patient Selection; D010477:Perfusion; D019999:Pharmaceutical Solutions; D010865:Pilot Projects; D010952:Plasma Substitutes / Q000627:therapeutic use*; D013318:Stroke Volume / Q000187:drug effects / Q000502:physiology; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D002316:Cardiotonic Agents; D000077324:Crystalloid Solutions; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D019999:Pharmaceutical Solutions; D010952:Plasma Substitutes; D014662:Vasoconstrictor Agents