Closed-loop goal-directed fluid therapy with colloids is associated with lower volume infused and fewer postoperative complications than with crystalloids.

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• Alexandre Joosten, Amelie Delaporte, Brigitte Ickx, Karim Touihri, Ida Stany, Luc Barvais, Luc Van Obbergh, Patricia Loi, Joseph Rinehart, Maxime Cannesson, and Philippe Van der Linden.
• From the Department of Anesthesiology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium (A.J., B.I., K.T., L.B., L.V.O.); Department of Anesthesiology, Brugmann Hospital, Université Libre de Bruxelles, Brussels, Belgium (A.D., I.S., P.V.d.L.); Department of Abdominal Surgery, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium (P.L.); Department of Anesthesiology and Perioperative Medicine, University of California Irvine, Irvine, California (J.R.); and Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (M.C.).
• Anesthesiology. 2018 Jan 1; 128 (1): 55-66.

BackgroundThe 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.MethodsOne 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.ResultsPatients 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.ConclusionsUnder 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.

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