CRYSTALLOID VS COLLOID RESUSCITATION - IS ONE BETTER - RANDOMIZED CLINICAL-STUDY

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  • 1 January 1979
    • journal article
    • research article
    • Vol. 85  (2) , 129-139
Abstract
The effects of hemodynamic resuscitation with protein-containing or balanced salt solution were studied prospectively in 29 patients undergoing abdominal aortic surgery. Blood loss was replaced with packed red cells and rextracellular volume with Ringer''s lactate (RL) or 5% albumin in Ringer''s lactate (ALB). Fluids were given to maintain the pulmonary capillary wedge pressure (PCWP) equal to or within 5 Torr above preoperative (PO) levels, the cardiac output (CO) equal to or greater than preoperative values and the urine output at least 50 ml/h. Serum colloid osmotic pressure (COP), CO, PCWP, the gradient between COP and PCWP (COP-PCWP), and intrapulmonary shunt (Qs/St) were measured PO, intraoperatively (IO) and daily for 3 days. The measured variables were similar PO in both groups. Operation time, estimated blood loss and transfusions were similar. Total fluids received for resuscitation (day of operation) was 11.3 .+-. 0.8 l (RL) and 6.2 .+-. 0.4 l (ALB). Fluid balance at the end of resuscitation was 8.4 .+-. 0.8 l (RL) and 3.4 .+-. 0.5 l (ALB). Maximum decrease in COP was 40% (P < 0.001) in the RL group and was insignificant in the ALB group. The COP-PCWP decreased from 11 .+-. 1 to 2 .+-. 1 in RL (P < 0.001) and insignificantly in ALB. Qs/Qt increased slightly in both groups following operation but was not different between groups. Fluid balance, total fluid infused, Na balance, total Na infused, COP or COP-PCWP did not significantly correlate with Qs/Qt. Two patients in the ALB group expierenced pulmonary edema associated with normal COP and elevated PCWP. There were no cases of pulmonary edema associated with low COP and normal PCWP in the crystalloid group. These data seriously question the necessity to maintain COP by using protein-containing solutions during acute hemodynamic resuscitation. When titrated to physiological end points, even large volumes of balanced salt solutions are well tolerated.