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

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• 作者：Joanne Verheij (1) (2)
  Arthur van Lingen (2) (3)
  Albertus Beishuizen (1) (2)
  Herman M. T. Christiaans (4)
  Jan R. de Jong (4)
  Armand R. J. Girbes (1) (2)
  Willem Wisselink (5)
  Jan A. Rauwerda (5)
  Marinus A. J. M. Huybregts (6)
  A. B. Johan Groeneveld (1) (2)
  
• 关键词：Colloids ; Crystalloids ; Cardiac contractility ; Cardiac compliance ; Preload ; recruitable stroke work ; Hypovolaemia ; Global end ; diastolic volume ; Fluid responsiveness
• 刊名：Intensive Care Medicine
• 出版年：2006
• 出版时间：July 2006
• 年：2006
• 卷：32
• 期：7
• 页码：1030-1038
• 全文大小：231KB
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• 作者单位：Joanne Verheij (1) (2)
  Arthur van Lingen (2) (3)
  Albertus Beishuizen (1) (2)
  Herman M. T. Christiaans (4)
  Jan R. de Jong (4)
  Armand R. J. Girbes (1) (2)
  Willem Wisselink (5)
  Jan A. Rauwerda (5)
  Marinus A. J. M. Huybregts (6)
  A. B. Johan Groeneveld (1) (2)
  
  1. Department of Intensive Care, VU Medical Centre, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
  2. Institute for Cardiovascular Research, VU Medical Centre, Amsterdam, The Netherlands
  3. Department of Nuclear Medicine, VU Medical Centre, Amsterdam, The Netherlands
  4. Department of Anaesthesiology, VU Medical Centre, Amsterdam, The Netherlands
  5. Department of Vascular Surgery, VU Medical Centre, Amsterdam, The Netherlands
  6. Department of Cardiothoracic Surgery, VU Medical Centre, Amsterdam, The Netherlands
  

文摘

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--7) 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 (1300-800) ml of saline or 1600 (750-800) ml of colloid solution (P<-.005) was infused. Colloid osmotic pressure (COP) decreased in the saline group and increased in the colloid groups (P<-.001). Plasma volume increased by 3.0% (-8 to 24) in the saline versus 19% (-1 to 50) in the colloid groups (P<-.001). Cardiac index increased by median 13% (ns) in the saline group and by 22% in the colloid groups (P<-.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.