title: Perioperative fluid therapy with tetrastarch and gelatin in cardiac surgery--a prospective sequential analysis*.
abstract: OBJECTIVE
  To determine clinical outcomes of synthetic colloids, tetrastarch, and gelatin, used before and after cardiac surgery.
  
  
  METHODS
  Prospective observational cohort study.
  
  
  METHODS
  Fifty-bed cardiac ICU.
  
  
  METHODS
  Six thousand four hundred seventy-eight consecutive patients with cardiopulmonary bypass surgery.
  
  
  METHODS
  Fluid therapy in the operating room and on the ICU directed at preset hemodynamic goals: 1) hydroxyethyl starch (predominantly 6% hydroxyethyl starch 130/0.4) in 2004-2006, n = 2,137; 2) 4% gelatin in 2006-2008, n = 2,324; and 3) only crystalloids in 2008-2010, n = 2,017.
  
  
  RESULTS
  Renal replacement therapy was more common during periods when patients received synthetic colloids compared to only crystalloids. Risk of renal replacement therapy was greater after hydroxyethyl starch (odds ratio, 2.29; 95% CI, 1.47-3.60) and gelatin (odds ratio, 2.75; 95% CI, 1.84-4.16; both p < 0.001) compared to crystalloid. Propensity score stratification confirmed greater use of renal replacement therapy in the hydroxyethyl starch and gelatin periods compared to the crystalloid period (odds ratio, 1.46 [1.08, 1.97]; p = 0.013 and odds ratio, 1.72 [1.33, 2.24]; p < 0.001, respectively). Time to vasopressor cessation, normalization of serum lactate, and mean arterial pressure did not differ among groups. Total fluid requirement was 163 mL/kg in the hydroxyethyl starch period, 207 mL/kg in the gelatin period, and 224 mL/kg in the crystalloid period. Fluid intake was higher in the crystalloid group only during the first 20 hours.
  
  
  CONCLUSIONS
  In cardiac surgery patients, fluid therapy with perioperative administration of synthetic colloids carries a high risk of renal replacement therapy and is not more effective than treating with only crystalloids.
authors: 1Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany. 2Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany. 3Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany. 4Department of Medicine, McMaster University, Hamilton, ON, Canada. 5Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. 6Department of Mechanical and Process Engineering, Furtwangen University, Villingen-Schwenningen, Germany.
authors: Ole
authors: O
authors: Bayer
authors: Daniel
authors: D
authors: Schwarzkopf
authors: Torsten
authors: T
authors: Doenst
authors: Deborah
authors: D
authors: Cook
authors: Bjoern
authors: B
authors: Kabisch
authors: Christoph
authors: C
authors: Schelenz
authors: Michael
authors: M
authors: Bauer
authors: Niels C
authors: NC
authors: Riedemann
authors: Yasser
authors: Y
authors: Sakr
authors: Matthias
authors: M
authors: Kohl
authors: Konrad
authors: K
authors: Reinhart
authors: Christiane S
authors: CS
authors: Hartog
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods*; D000077324:Crystalloid Solutions; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects* / Q000379:methods*; D005780:Gelatin / Q000008:administration & dosage / Q000009:adverse effects; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage / Q000009:adverse effects; D007362:Intensive Care Units; D007552:Isotonic Solutions / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000209:etiology*; D017582:Renal Replacement Therapy; D014882:Water-Electrolyte Balance
chemical_list: D000077324:Crystalloid Solutions; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D005780:Gelatin