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

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Abstract

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 = 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< 0.005) was infused. Colloid osmotic pressure (COP) decreased in the saline group and increased in the colloid groups (P< 0.001). Plasma volume increased by 3.0% (–18 to 24) in the saline versus 19% (–11 to 50) in the colloid groups (P< 0.001). Cardiac index increased by median 13% (ns) in the saline group and by 22% in the colloid groups (P< 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.

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Acknowledgements

We are indebted to Leo Stokkel, Pieter G.H.M. Raijmakers, G.J. Jaap Teule, Kees H. Polderman, Jan Jaap Spijkstra, Rob J.M. Strack van Schijndel and Arie C. van Loenen, and to B. Braun Medical for an unrestricted research grant supporting the first author.

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Authors and Affiliations

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

    Joanne Verheij, Albertus Beishuizen, Armand R. J. Girbes & A. B. Johan Groeneveld

  2. Institute for Cardiovascular Research, VU Medical Centre, Amsterdam, The Netherlands

    Joanne Verheij, Arthur van Lingen, Albertus Beishuizen, Armand R. J. Girbes & A. B. Johan Groeneveld

  3. Department of Nuclear Medicine, VU Medical Centre, Amsterdam, The Netherlands

    Arthur van Lingen

  4. Department of Anaesthesiology, VU Medical Centre, Amsterdam, The Netherlands

    Herman M. T. Christiaans & Jan R. de Jong

  5. Department of Vascular Surgery, VU Medical Centre, Amsterdam, The Netherlands

    Willem Wisselink & Jan A. Rauwerda

  6. Department of Cardiothoracic Surgery, VU Medical Centre, Amsterdam, The Netherlands

    Marinus A. J. M. Huybregts

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  1. Joanne Verheij
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  9. A. B. Johan Groeneveld
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Correspondence to A. B. Johan Groeneveld.

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Verheij, J., van Lingen, A., Beishuizen, A. et al. Cardiac response is greater for colloid than saline fluid loading after cardiac or vascular surgery. Intensive Care Med 32, 1030–1038 (2006). https://doi.org/10.1007/s00134-006-0195-5

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  • DOI: https://doi.org/10.1007/s00134-006-0195-5

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