Haemodynamic response to crystalloids or colloids in shock: an exploratory subgroup analysis of a randomised controlled trial

Abstract

Objective: To compare the haemodynamic effect of crystalloids and colloids during acute severe hypovolaemic shock.

Design: Exploratory subgroup analysis of a multicentre randomised controlled trial (Colloids Versus Crystalloids for the Resuscitation of the Critically Ill, CRISTAL, ClinicalTrials.gov NCT00318942).

Setting: CRISTAL was conducted in intensive care units in Europe, North Africa and Canada.

Participants: Current analysis included all patients who had a pulmonary artery catheter in place at randomisation. 220 patients (117 received crystalloids vs 103 colloids) underwent pulmonary artery catheterisation.

Intervention: Crystalloids versus colloids for fluid resuscitation in hypovolaemic shock.

Outcome measures: Haemodynamic data were collected at the time of randomisation and subsequently on days 1, 2, 3, 4, 5, 6 and 7.

Results: Median cumulative volume of fluid administered during the first 7 days was higher in the crystalloids group than in the colloids group (3500 (2000-6000) vs 2500 (1000-4000) mL, p=0.01). Patients in the colloids arm exhibited a lower heart rate over time compared with those allocated to the crystalloids arm (p=0.014). There was no significant difference in Cardiac Index (p=0.053), mean blood pressure (p=0.4), arterial lactates (p=0.9) or global Sequential Organ Failure Assessment score (p=0.3) over time between arms.

Conclusions: During acute severe hypovolaemic shock, patients monitored by a pulmonary artery catheter achieved broadly similar haemodynamic outcomes, using lower volumes of colloids than crystalloids. The heart rate was lower in the colloids arm.

Keywords: colloid; crystalloid; fluid resuscitation; intensive care unit (icu); pulmonary artery catheter.

Figure 1

Box plot showing heart rate distribution over the first 7 days following randomisation in both arms. The horizontal line in the box indicates the median value, whereas the lines at the top and bottom of the box indicate IQR. Day 0, day of randomisation. bpm, beats/min.

Figure 2

Box plot showing Cardiac Index distribution over the first 7 days following randomisation in both arms. The horizontal line in the box indicates the median value, whereas the lines at the top and bottom of the box indicate IQR. Day 0, day of randomisation.

Figure 3

Box plot showing the rate–pressure product distribution over the first 7 days following randomisation in both arms. The horizontal line in the box indicates the median value, whereas the lines at the top and bottom of the box indicate IQR. Day 0, day of randomisation.