Effects of fluid resuscitation with synthetic colloids or crystalloids alone on shock reversal, fluid balance, and patient outcomes in patients with severe sepsis: A prospective sequential analysis
Critical Care Medicine, 08/20/2012
Bayer O et al. – Shock reversal was achieved equally fast with synthetic colloids or crystalloids. Use of colloids resulted in only marginally lower required volumes of resuscitation fluid. Both low molecular weight hydroxyethyl starch and gelatin may impair renal function.Methods
- Fluid therapy directed at preset hemodynamic goals with hydroxyethyl starch (predominantly 6% hydroxyethyl starch 130/0.4) in the first period, 4% gelatin in the second period, and only crystalloids in the third period.
- Main outcome was time to shock reversal (serum lactate <2.2mmol/L and discontinuation of vasopressor use).
- Hemodynamic goals were mean arterial pressure >70mm Hg; ScvO2<70%; central venous pressure >8mm Hg.
- Safety outcomes were acute kidney injury defined by Risk, Injury, Failure, Loss, and End-stage kidney disease criteria and new need for renal replacement therapy.
- Hemodynamic measures, serum lactate, and creatinine were comparable at baseline in all study periods (hydroxyethyl starch n=360, gelatin n=352, only crystalloids n=334).
- Severity scores, hospital length of stay, and intensive care unit or hospital mortality did not differ significantly among groups.
- All groups showed similar time to shock reversal.
- More fluid was needed over the first 4days in the crystalloid group (fluid ratios 1.4:1 [crystalloids to hydroxyethyl starch] and 1.1:1 [crystalloids to gelatin]).
- After day 5, fluid balance was more negative in the crystalloid group.
- Hydroxyethyl starch and gelatin were independent risk factors for acute kidney injury (odds ratio, 95% confidence interval 2.55, 1.76–3.69 and 1.85, 1.31–2.62, respectively).
- Patients receiving synthetic colloids received significantly more allogeneic blood products.