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Randomized Controlled Trial
. 2010 Apr;36(4):697-701.
doi: 10.1007/s00134-010-1776-x. Epub 2010 Feb 18.

Greater cardiac response of colloid than saline fluid loading in septic and non-septic critically ill patients with clinical hypovolaemia

Ronald J Trof  1 , Sharwan P Sukul, Jos W R Twisk, Armand R J Girbes, A B Johan Groeneveld
Affiliations
Randomized Controlled Trial

Greater cardiac response of colloid than saline fluid loading in septic and non-septic critically ill patients with clinical hypovolaemia

Ronald J Trof et al. Intensive Care Med. 2010 Apr.

Abstract

Background and objective: The haemodynamics of crystalloid and colloid fluid loading may depend on underlying disease, i.e. sepsis versus non-sepsis.

Design and setting: A single-centre, single-blinded, randomized clinical trial was carried out on 24 critically ill sepsis and 24 non-sepsis patients with clinical hypovolaemia, assigned to loading with normal saline, gelatin 4%, hydroxyethyl starch 6% or albumin 5% in a 90-min (delta) central venous pressure (CVP)-guided fluid loading protocol. Transpulmonary thermodilution was done each 30 min, yielding, among others, global end-diastolic volume and cardiac indices (GEDVI, CI).

Results: Sepsis patients had hyperdynamic hypotension in spite of myocardial depression and dilatation, and greater inotropic/vasopressor requirements than non-sepsis patients. Independent of underlying disease, CVP and GEDVI increased more after colloid than saline loading (P < 0.018), so that CI increased by about 2% after saline and 12% after colloid loading (P = 0.029). The increase in preload-recruitable stroke work was also greater with colloids and did not differ among conditions.

Conclusion: Fluid loading with colloids results in a greater linear increase in cardiac filling, output and stroke work than does saline loading, in both septic and non-septic clinical hypovolaemia, in spite of myocardial depression and presumably increased vasopermeability potentially decreasing the effects of colloid fluid loading in the former.

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Figures

Fig. 1
Fig. 1
a Mean ± SEM for cardiac index (CI) versus global end-diastolic volume index (GEDVI) according to fluid type (A saline; B colloid), at four time points of fluid loading, in non-sepsis patients. b Mean ± SEM for cardiac index (CI) versus global end-diastolic volume index (GEDVI) according to fluid type (A saline; B colloid), at four time points of fluid loading, in sepsis patients. For GEDVI and CI: increases differed between fluid types (P = 0.007 or lower), indicating greater rises in colloid than in saline loading, irrespective of underlying disease
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