title: Influence of goal-directed therapy with balanced crystalloid-colloid or unbalanced crystalloid solution on base excess.
abstract: OBJECTIVE
  To investigate changes in standard base excess (SBE) when administering two different infusion regimens for elective hip replacement within a goal-directed haemodynamic algorithm.
  
  
  METHODS
  This prospective, double-blind, randomized, controlled study enrolled patients scheduled for primary hip replacement surgery, who were randomized to receive either an unbalanced crystalloid (chloride: 155.5 mmol/l) or a 1 : 1 mixture of a balanced crystalloid and a balanced colloid (6% w/v hydroxyethyl starch 130/0.42; chloride: 98 and 112 mmol/l, respectively). Fluid management was goal-directed to optimize stroke volume using oesophageal Doppler.
  
  
  RESULTS
  A total of 40 patients (19 female/21 male) participated in the study. After surgery, median (25-75% percentiles) SBE was significantly lower in the unbalanced group compared with the balanced group: -2.0 mmol/l (-3.1 to -1.1) versus -0.4 mmol/l (-1.2 to 0.7), respectively. This difference was mainly due to greater plasma chloride concentrations in the unbalanced group. The amount of study medication required to reach haemodynamic stability (median 1200 ml) did not differ between the two groups.
  
  
  CONCLUSIONS
  SBE decreased in the unbalanced group without influence on fluid requirements and haemodynamic stability.
authors: Department of Anaesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Campus Charité Mitte and Campus Charité Virchow-Klinikum, Berlin, Germany.
authors: Holger
authors: H
authors: Krebbel
authors: Aarne
authors: A
authors: Feldheiser
authors: Olga
authors: O
authors: Müller
authors: Willehad
authors: W
authors: Boemke
authors: Michael
authors: M
authors: Sander
authors: Carsten
authors: C
authors: Perka
authors: Klaus-Dieter
authors: KD
authors: Wernecke
authors: Claudia
authors: C
authors: Spies
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D002712:Chlorides / Q000097:blood / Q000627:therapeutic use*; D003102:Colloids / Q000627:therapeutic use*; D000077324:Crystalloid Solutions; D004311:Double-Blind Method; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use*; D007552:Isotonic Solutions / Q000627:therapeutic use*; D008297:Male; D010952:Plasma Substitutes / Q000008:administration & dosage; D011446:Prospective Studies
chemical_list: D002712:Chlorides; D003102:Colloids; D000077324:Crystalloid Solutions; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes
keywords: Base excess; Plasma Volume Redibag®; Plasma-Lyte®; Stewart–Fencl approach; goal-directed fluid therapy; starch