Crystalloid versus Colloid for Intraoperative Goal-directed Fluid Therapy Using a Closed-loop System: A Randomized, Double-blinded, Controlled Trial in Major Abdominal Surgery

• Published in: Anesthesiology (Philadelphia) 2018-01, Vol.128 (1), p.55-66
• Main Authors: Joosten, Alexandre, Delaporte, Amelie, Ickx, Brigitte, Touihri, Karim, Stany, Ida, Barvais, Luc, Van Obbergh, Luc, Loi, Patricia, Rinehart, Joseph, Cannesson, Maxime, Van der Linden, Philippe
• Format: Article
• Language: English
• Subjects: Abdomen - surgery; Aged; Colloids - administration & dosage; Crystalloid Solutions; Double-Blind Method; Elective Surgical Procedures - methods; Female; Fluid Therapy - methods; Humans; Intraoperative Care - methods; Isotonic Solutions - administration & dosage; Male; Middle Aged; Patient Care Planning; Prospective Studies
• ISSN: 0003-3022; 1528-1175
• DOI: 10.1097/ALN.0000000000001936

BACKGROUND:The type of fluid and volume regimen given intraoperatively both can impact patient outcome after major surgery. This two-arm, parallel, randomized controlled, double-blind, bi-center superiority study tested the hypothesis that when using closed-loop assisted goal-directed fluid therapy, balanced colloids are associated with fewer postoperative complications compared to balanced crystalloids in patients having major elective abdominal surgery. METHODS:One hundred and sixty patients were enrolled in the protocol. All patients had maintenance-balanced crystalloid administration of 3 ml · kg · h. A closed-loop system delivered additional 100-ml fluid boluses (patients were randomized to receive either a balanced-crystalloid or colloid solution) according to a predefined goal-directed strategy, using a stroke volume and stroke volume variation monitor. All patients were included in the analysis. The primary outcome was the Post-Operative Morbidity Survey score, a nine-domain scale, at day 2 postsurgery. Secondary outcomes included all postoperative complications. RESULTS:Patients randomized in the colloid group had a lower Post-Operative Morbidity Survey score (median [interquartile range] of 2 [1 to 3] vs. 3 [1 to 4], difference –1 [95% CI, –1 to 0]; P < 0.001) and a lower incidence of postoperative complications. Total volume of fluid administered intraoperatively and net fluid balance were significantly lower in the colloid group. CONCLUSIONS:Under our study conditions, a colloid-based goal-directed fluid therapy was associated with fewer postoperative complications than a crystalloid one. This beneficial effect may be related to a lower intraoperative fluid balance when a balanced colloid was used. However, given the study design, the mechanism for the difference cannot be determined with certainty.