Effect of Intraoperative Goal-directed Balanced Crystalloid versus Colloid Administration on Major Postoperative Morbidity

A Randomized Trial

Crystalloid–Colloid Study Team

Research output: Contribution to journalArticle

Abstract

WHAT WE ALREADY KNOW ABOUT THIS TOPIC: WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Crystalloid 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. METHODS: In 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. RESULTS: A 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. CONCLUSIONS: Doppler-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.

Original languageEnglish (US)
Pages (from-to)728-744
Number of pages17
JournalAnesthesiology
Volume130
Issue number5
DOIs
StatePublished - May 1 2019
Externally publishedYes

Fingerprint

Colloids
Morbidity
Kidney
Hydroxyethyl Starch Derivatives
Critical Care
crystalloid solutions
Starch
General Anesthesia
Multicenter Studies
Creatinine
Hemodynamics
Safety
Lung
Serum

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Effect of Intraoperative Goal-directed Balanced Crystalloid versus Colloid Administration on Major Postoperative Morbidity : A Randomized Trial. / Crystalloid–Colloid Study Team.

In: Anesthesiology, Vol. 130, No. 5, 01.05.2019, p. 728-744.

Research output: Contribution to journalArticle

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abstract = "WHAT WE ALREADY KNOW ABOUT THIS TOPIC: WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Crystalloid 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. METHODS: In 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. RESULTS: A 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. CONCLUSIONS: Doppler-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.",
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T2 - A Randomized Trial

AU - Crystalloid–Colloid Study Team

AU - Kabon, Barbara

AU - Sessler, Daniel I.

AU - Kurz, Andrea

AU - Maheshwari, Kamal

AU - Babazade, Rovnat

AU - Fiffick, Alexa

AU - Gazmuri, Ignacia

AU - Ghobrial, Michael

AU - Honar, Hooman

AU - Kot, Michael

AU - Kopyeva, Tatyana

AU - Koyuncu, Onur

AU - Lavery, Ian

AU - Mascha, Edward J.

AU - Naylor, Amanda

AU - Podolyak, Attila

AU - Reville, Eric

AU - Saxon, Joseph

AU - Suleiman, Iman

AU - Yang, Dongsheng

AU - You, Jing

AU - Dietz, David W.

AU - Fleischmann, Edith

AU - Reiterer, Christian

AU - Zotti, Oliver M.

AU - Stift, Anton

AU - Gruenberger, Thomas

AU - Obradovic, Mina

AU - Luf, Florian

AU - Muehlbacher, Jakob

AU - Sljivic, Samir

AU - Bayoumi, Ahmed

AU - Marschalek, Corinna

AU - Kaserer, Alexander

AU - Rahimi, Jasmin

AU - Eredics, Klaus

AU - Krischer, Benedict

AU - Erdik, Erol

AU - Rech, Jonas

AU - Bergese, Sergio

PY - 2019/5/1

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