Cardiac Surgery

Cardiac response is greater for colloid than saline fluid loading after cardiac or vascular surgery.

Intensive Care Med. 2006 May 23

Verheij J, van Lingen A, Beishuizen A, Christiaans HM, de Jong JR, Girbes AR, Wisselink W, Rauwerda JA, Huybregts MA, Groeneveld AB.

Department of Intensive Care, VU Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.

OBJECTIVE: To study the effects on volume expansion and myocardial function of colloids or crystalloids in the treatment of hypovolaemic hypotension after cardiac and major vascular surgery. DESIGN AND SETTING: A single-centre, single-blinded, randomized clinical trial at the intensive care unit of a university hospital.

PATIENTS AND METHODS: Patients (n[Symbol: see text]=[Symbol: see text]67) were subjected to a 90-min filling pressure-guided fluid challenge with saline 0.9% or the colloids gelatin 4%, hydroxyethyl starch 6% or albumin 5%. Biochemical variables and haemodynamics (transpulmonary thermodilution) were measured. RESULTS: An amount of 1800 (1300-1800) ml of saline or 1600 (750-1800) ml of colloid solution (P<[Symbol: see text]0.005) was infused. Colloid osmotic pressure (COP) decreased in the saline group and increased in the colloid groups (P<[Symbol: see text]0.001). Plasma volume increased by 3.0% (-18 to 24) in the saline versus 19% (-11 to 50) in the colloid groups (P<[Symbol: see text]0.001). Cardiac index increased by median 13% (ns) in the saline group and by 22% in the colloid groups (P<[Symbol: see text]0.005). The rise in left ventricular stroke work index was greater in the colloid than in the saline groups. The different colloids were equally effective. The rise in cardiac index related to the rise in plasma volume and global end-diastolic volume, confirming plasma volume and preload augmentation by the fluid loading. CONCLUSION: After cardiac or major vascular surgery, the pressure- and time-guided fluid response is dependent on the type of fluid used. Colloid fluid loading leads to a greater increase in preload-recruitable cardiac and left ventricular stroke work indices than that with saline, because of greater plasma volume expansion following an increase in plasma COP.