Short-term effectiveness of different volume replacement therapies in postoperative hypovolaemic patients

BACKGROUND AND OBJECTIVETo examine the kinetics of volume loading with crystalloid and colloid infusions in critically ill patients after major surgery, using the pulse contour cardiac output (PiCCO) monitoring technique. METHODSThis prospective, randomized, multicentre study of 11 ICUs involved 200 mixed postoperative hypovolaemic patients (50 patients per group) in Hungary. Patients received 10 ml kg of lactated Ringerʼs solution, succinylated gelatin 4% w/v, 130/0.4 hydroxyethyl starch 6% w/v (HES) or human albumin 5% w/v over 30 min. A complete haemodynamic profile was obtained at 30, 45, 60, 90 and 120 min after baseline. The peak haemodynamic effects, the 120 min changes compared with baseline, the area under the curve (AUC) for the haemodynamic parameters over 120 min and the haemodilution effect of the solutions were analysed. The primary outcome was to compare the AUCs and the secondary outcome was to evaluate the haemodynamic changes at 120 min. RESULTSThere were significant differences in the AUCs of the haemodynamic parameters between colloids and lactated Ringerʼs solution in the cardiac index and global end-diastolic volume index (GEDVI); human albumin vs. lactated Ringerʼs solution in stroke volume variation (SVV); and succinylated gelatin, HES vs. lactated Ringerʼs solution in the oxygen delivery index (DO2I). Colloid infusions (mainly HES and human albumin) at 120 min caused significant changes in central venous pressure, cardiac index, GEDVI, SVV, DO2I and central venous oxygen saturation compared with baseline. The haemodilution effect was significantly greater in colloids vs. lactated Ringerʼs solution. CONCLUSIONIn postoperative hypovolaemic patients, lactated Ringerʼs solution can significantly improve haemodynamics at the end of volume loading, but this effect completely disappears at 120 min. Ten millilitres per kilogram of colloid bolus (especially HES) improved the haemodynamics at 120 min; however, this was by only 5–25% compared with baseline. The colloids caused significantly larger AUCs than lactated Ringerʼs solution, but only in the cardiac index, GEDVI and DO2I, plus human albumin in the SVV.