• Ole Bayer, Daniel Schwarzkopf, Torsten Doenst, Deborah Cook, Bjoern Kabisch, Christoph Schelenz, Michael Bauer, Niels C Riedemann, Yasser Sakr, Matthias Kohl, Konrad Reinhart, and Christiane S Hartog.
• 1Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany. 2Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany. 3Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany. 4Department of Medicine, McMaster University, Hamilton, ON, Canada. 5Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada. 6Department of Mechanical and Process Engineering, Furtwangen University, Villingen-Schwenningen, Germany.
• Crit. Care Med. 2013 Nov 1; 41 (11): 2532-42.

ObjectivesTo determine clinical outcomes of synthetic colloids, tetrastarch, and gelatin, used before and after cardiac surgery.DesignProspective observational cohort study.SettingFifty-bed cardiac ICU.PatientsSix thousand four hundred seventy-eight consecutive patients with cardiopulmonary bypass surgery.InterventionsFluid therapy in the operating room and on the ICU directed at preset hemodynamic goals: 1) hydroxyethyl starch (predominantly 6% hydroxyethyl starch 130/0.4) in 2004-2006, n = 2,137; 2) 4% gelatin in 2006-2008, n = 2,324; and 3) only crystalloids in 2008-2010, n = 2,017.Measurements And Main ResultsRenal replacement therapy was more common during periods when patients received synthetic colloids compared to only crystalloids. Risk of renal replacement therapy was greater after hydroxyethyl starch (odds ratio, 2.29; 95% CI, 1.47-3.60) and gelatin (odds ratio, 2.75; 95% CI, 1.84-4.16; both p < 0.001) compared to crystalloid. Propensity score stratification confirmed greater use of renal replacement therapy in the hydroxyethyl starch and gelatin periods compared to the crystalloid period (odds ratio, 1.46 [1.08, 1.97]; p = 0.013 and odds ratio, 1.72 [1.33, 2.24]; p < 0.001, respectively). Time to vasopressor cessation, normalization of serum lactate, and mean arterial pressure did not differ among groups. Total fluid requirement was 163 mL/kg in the hydroxyethyl starch period, 207 mL/kg in the gelatin period, and 224 mL/kg in the crystalloid period. Fluid intake was higher in the crystalloid group only during the first 20 hours.ConclusionsIn cardiac surgery patients, fluid therapy with perioperative administration of synthetic colloids carries a high risk of renal replacement therapy and is not more effective than treating with only crystalloids.

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