Original

Intensive Care Medicine

, Volume 32, Issue 7, pp 1030-1038

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

  • Joanne VerheijAffiliated withDepartment of Intensive Care, VU Medical CentreInstitute for Cardiovascular Research, VU Medical Centre
  • , Arthur van LingenAffiliated withInstitute for Cardiovascular Research, VU Medical CentreDepartment of Nuclear Medicine, VU Medical Centre
  • , Albertus BeishuizenAffiliated withDepartment of Intensive Care, VU Medical CentreInstitute for Cardiovascular Research, VU Medical Centre
  • , Herman M. T. ChristiaansAffiliated withDepartment of Anaesthesiology, VU Medical Centre
  • , Jan R. de JongAffiliated withDepartment of Anaesthesiology, VU Medical Centre
  • , Armand R. J. GirbesAffiliated withDepartment of Intensive Care, VU Medical CentreInstitute for Cardiovascular Research, VU Medical Centre
  • , Willem WisselinkAffiliated withDepartment of Vascular Surgery, VU Medical Centre
  • , Jan A. RauwerdaAffiliated withDepartment of Vascular Surgery, VU Medical Centre
  • , Marinus A. J. M. HuybregtsAffiliated withDepartment of Cardiothoracic Surgery, VU Medical Centre
    • , A. B. Johan GroeneveldAffiliated withDepartment of Intensive Care, VU Medical CentreInstitute for Cardiovascular Research, VU Medical Centre Email author 

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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.

Keywords

Colloids- Crystalloids Cardiac contractility Cardiac compliance Preload-recruitable stroke work Hypovolaemia Global end-diastolic volume Fluid responsiveness