Newly Published
Perioperative Medicine  |   October 2017
Crystalloid versus Colloid for Intraoperative Goal-directed Fluid Therapy Using a Closed-loop System: A Randomized, Double-blinded, Controlled Trial in Major Abdominal Surgery
Author Notes
  • From the Department of Anesthesiology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium (A.J., B.I., K.T., L.B., L.V.O.); Department of Anesthesiology, Brugmann Hospital, Université Libre de Bruxelles, Brussels, Belgium (A.D., I.S., P.V.d.L.); Department of Abdominal Surgery, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium (P.L.); Department of Anesthesiology and Perioperative Medicine, University of California Irvine, Irvine, California (J.R.); and Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California (M.C.).
  • A.J. and A.D. are co-first authors.
    A.J. and A.D. are co-first authors.×
  • Submitted for publication February 8, 2017. Accepted for publication September 15, 2017.
    Submitted for publication February 8, 2017. Accepted for publication September 15, 2017.×
  • Acknowledgments: The authors would like to thank the following persons: research pharmacists Nabil Hayef (Brugmann Hospital, Brussels, Belgium) and Astrid Vandorpe (Erasme Hospital, Brussels, Belgium) for the blinded study solutions; Brenton Alexander, M.D. (University of California San Diego, California), for English editing and content organization; and Celine Boudart, M.D., Sean Coeckelenbergh, M.D., and Amine Kharroubi, M.D., (Department of Anesthesiology, Erasme Hospital, Brussels, Beligium) for data acquisition in the postoperative period.
    Acknowledgments: The authors would like to thank the following persons: research pharmacists Nabil Hayef (Brugmann Hospital, Brussels, Belgium) and Astrid Vandorpe (Erasme Hospital, Brussels, Belgium) for the blinded study solutions; Brenton Alexander, M.D. (University of California San Diego, California), for English editing and content organization; and Celine Boudart, M.D., Sean Coeckelenbergh, M.D., and Amine Kharroubi, M.D., (Department of Anesthesiology, Erasme Hospital, Brussels, Beligium) for data acquisition in the postoperative period.×
  • Research Support: This trial was supported by grants from the European Society of Intensive Care Medicine (Baxter Award 2015; Berlin, Germany), the Belgium Society of Anesthesiology (2015; Brussels, Belgium), and the Brugmann Foundation (2015; Brussels, Belgium).
    Research Support: This trial was supported by grants from the European Society of Intensive Care Medicine (Baxter Award 2015; Berlin, Germany), the Belgium Society of Anesthesiology (2015; Brussels, Belgium), and the Brugmann Foundation (2015; Brussels, Belgium).×
  • Competing Interests: Dr. Van der Linden has received, within the past 5 yr, fees for lectures and consultancies from Fresenius Kabi GmbH (Bad Homburg, Germany) and Janssen-Cilag SA (Beerse, Belgium). Dr. Joosten is a consultant for Edwards LifeSciences (Irvine, California). Dr. Cannesson and Dr. Rinehart declare ownership interest in Sironis (Newport Beach, California), a company developing closed-loop systems, and consultancy for Edwards Lifesciences. The other authors declare no competing interests.
    Competing Interests: Dr. Van der Linden has received, within the past 5 yr, fees for lectures and consultancies from Fresenius Kabi GmbH (Bad Homburg, Germany) and Janssen-Cilag SA (Beerse, Belgium). Dr. Joosten is a consultant for Edwards LifeSciences (Irvine, California). Dr. Cannesson and Dr. Rinehart declare ownership interest in Sironis (Newport Beach, California), a company developing closed-loop systems, and consultancy for Edwards Lifesciences. The other authors declare no competing interests.×
  • Reproducible Science: Full protocol available at: Alexandre.Joosten@erasme.ulb.ac.be. Raw data available at: Alexandre.Joosten@erasme.ulb.ac.be.
    Reproducible Science: Full protocol available at: Alexandre.Joosten@erasme.ulb.ac.be. Raw data available at: Alexandre.Joosten@erasme.ulb.ac.be.×
  • Correspondence: Address correspondence to Dr. Joosten: Department of Anesthesiology, CUB ERASME, 808, Route de Lennik, 1070 Brussels, Belgium. Alexandre.Joosten@erasme.ulb.ac.be. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue
Article Information
Perioperative Medicine / Renal and Urinary Systems / Electrolyte Balance
Perioperative Medicine   |   October 2017
Crystalloid versus Colloid for Intraoperative Goal-directed Fluid Therapy Using a Closed-loop System: A Randomized, Double-blinded, Controlled Trial in Major Abdominal Surgery
Anesthesiology Newly Published on October 26, 2017. doi:10.1097/ALN.0000000000001936
Anesthesiology Newly Published on October 26, 2017. doi:10.1097/ALN.0000000000001936
Abstract

Background: The type of fluid and volume regimen given intraoperatively both can impact patient outcome after major surgery. This two-arm, parallel, randomized controlled, double-blind, bi-center superiority study tested the hypothesis that when using closed-loop assisted goal-directed fluid therapy, balanced colloids are associated with fewer postoperative complications compared to balanced crystalloids in patients having major elective abdominal surgery.

Methods: One hundred and sixty patients were enrolled in the protocol. All patients had maintenance-balanced crystalloid administration of 3 ml · kg–1 · h–1. A closed-loop system delivered additional 100-ml fluid boluses (patients were randomized to receive either a balanced-crystalloid or colloid solution) according to a predefined goal-directed strategy, using a stroke volume and stroke volume variation monitor. All patients were included in the analysis. The primary outcome was the Post-Operative Morbidity Survey score, a nine-domain scale, at day 2 postsurgery. Secondary outcomes included all postoperative complications.

Results: Patients randomized in the colloid group had a lower Post-Operative Morbidity Survey score (median [interquartile range] of 2 [1 to 3] vs. 3 [1 to 4], difference –1 [95% CI, –1 to 0]; P < 0.001) and a lower incidence of postoperative complications. Total volume of fluid administered intraoperatively and net fluid balance were significantly lower in the colloid group.

Conclusions: Under our study conditions, a colloid-based goal-directed fluid therapy was associated with fewer postoperative complications than a crystalloid one. This beneficial effect may be related to a lower intraoperative fluid balance when a balanced colloid was used. However, given the study design, the mechanism for the difference cannot be determined with certainty.