• Barbara Kabon, Daniel I Sessler, Andrea Kurz, and Crystalloid–Colloid Study Team.
• From the Department of Anesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria (B.K.) the Departments of Outcomes Research (D.I.S., A.K.) General Anesthesiology (A.K.), Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio. Cleveland Clinic, Cleveland, Ohio Cleveland Clinic, Cleveland, Ohio Cleveland Clinic, Cleveland, Ohio Cleveland Clinic, Cleveland, Ohio Cleveland Clinic, Cleveland, Ohio Cleveland Clinic, Cleveland, Ohio Cleveland Clinic, Cleveland, Ohio Cleveland Clinic, Cleveland, Ohio Cleveland Clinic, Cleveland, Ohio Cleveland Clinic, Cleveland, Ohio Cleveland Clinic, Cleveland, Ohio Cleveland Clinic, Cleveland, Ohio Cleveland Clinic, Cleveland, Ohio Cleveland Clinic, Cleveland, Ohio Cleveland Clinic, Cleveland, Ohio Cleveland Clinic, Cleveland, Ohio Cleveland Clinic, Cleveland, Ohio Cleveland Clinic, Cleveland, Ohio Cleveland Clinic, Cleveland, Ohio Medical University of Vienna, Vienna, Austria Medical University of Vienna, Vienna, Austria Medical University of Vienna, Vienna, Austria Medical University of Vienna, Vienna, Austria Medical University of Vienna, Vienna, Austria Medical University of Vienna, Vienna, Austria Medical University of Vienna, Vienna, Austria Medical University of Vienna, Vienna, Austria Medical University of Vienna, Vienna, Austria Medical University of Vienna, Vienna, Austria Medical University of Vienna, Vienna, Austria Medical University of Vienna, Vienna, Austria Medical University of Vienna, Vienna, Austria Medical University of Vienna, Vienna, Austria Medical University of Vienna, Vienna, Austria Medical University of Vienna, Vienna, Austria Medical University of Vienna, Vienna, Austria Ohio State University, Columbus, Ohio.
• Anesthesiology. 2019 May 1; 130 (5): 728-744.

BackgroundCrystalloid solutions leave the circulation quickly, whereas colloids remain for hours, thus promoting hemodynamic stability. However, colloids are expensive and promote renal toxicity in critical care patients. This study tested the hypothesis that goal-directed colloid administration during elective abdominal surgery decreases 30-day major complications more than goal-directed crystalloid administration.MethodsIn this parallel-arm double-blinded multicenter randomized trial, adults having moderate- to high-risk open and laparoscopically assisted abdominal surgery with general anesthesia were randomly assigned to Doppler-guided intraoperative volume replacement with 6% hydroxyethyl starch 130/0.4 (n = 523) or lactated Ringer's solution (n = 534). The primary outcome was a composite of serious postoperative cardiac, pulmonary, infectious, gastrointestinal, renal, and coagulation complications that were assessed with a generalized estimating equation multivariate model. The primary safety outcome was a change in serum creatinine concentration up to 6 months postoperatively, compared to baseline concentrations.ResultsA total of 1,057 patients were included in the analysis. Patients assigned to crystalloid received a median [quartile 1, quartile 3] amount of 3.2 l [2.3, 4.4] of crystalloid, and patients assigned to colloid received 1.0 l [0.5, 1.5] of colloid and 1.8 l [1.2, 2.4] of crystalloid. The estimated intention-to-treat common effect relative risk for the primary composite was 0.90 for colloids versus crystalloids (95% CI: 0.65 to 1.23, P = 0.51), and 18% (91 of 523) of colloid patients and 20% (103 of 534) of crystalloid patients incurred at least one component of the primary outcome composite. There was no evidence of renal toxicity at any time.ConclusionsDoppler-guided intraoperative hydroxyethyl starch administration did not significantly reduce a composite of serious complications. However, there was also no indication of renal or other toxicity.

16 keywords...

hide…