Newly Published
Critical Care Medicine  |   September 2018
Morbidity and Mortality of Crystalloids Compared to Colloids in Critically Ill Surgical Patients: A Subgroup Analysis of a Randomized Trial
Author Notes
  • From the General Intensive Care Unit, Raymond Poincaré Hospital, Garches, France (N.H., L.L., D.A.); U1173 Lab Inflammation and Infection, University of Versailles SQY-Paris Saclay - INSERM, Montigny-le-Bretonneux, France (N.H., L.L., D.A.); Department of Anesthesiology and Critical Care Medicine B, Saint Eloi Hospital, Montpellier, France (S.J.); Intensive Care Unit, Institute of Cardiology, Pitié Salpêtrière Hospital, Paris, France (J.L.T.); Anaesthesiology-Emergency-Intensive Care Unit Department, AP-HM North Hospital, Marseille, France (C.M.); and Biostatistical Unit, Saint Louis Hospital, Paris, France (S.C.).
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Part of the work presented in this article has been presented at the 46th French Intensive Care Society Congress in Paris, France, January 24 to 26, 2018.
    Part of the work presented in this article has been presented at the 46th French Intensive Care Society Congress in Paris, France, January 24 to 26, 2018.×
  • Submitted for publication February 5, 2018. Accepted for publication July 20, 2018.
    Submitted for publication February 5, 2018. Accepted for publication July 20, 2018.×
  • Acknowledgments: The authors thank Julie Lejeune, M.S. (Biostatistical Unit, Saint Louis Hospital, Paris, France), for her technical assistance, as well as all the investigators and patients of the CRISTAL trial.
    Acknowledgments: The authors thank Julie Lejeune, M.S. (Biostatistical Unit, Saint Louis Hospital, Paris, France), for her technical assistance, as well as all the investigators and patients of the CRISTAL trial.×
  • Research Support: Supported in 2001 and 2010 by grant No. AOM 01 020 from the French Ministry of Health.
    Research Support: Supported in 2001 and 2010 by grant No. AOM 01 020 from the French Ministry of Health.×
  • Competing Interests: The authors declare no competing interests.
    Competing Interests: The authors declare no competing interests.×
  • Correspondence: Address correspondence to Dr. Annane: General Intensive Care Unit, Raymond Poincaré Hospital (AP-HP), University of Versailles Saint-Quentin en Yvelines 104, Boulevard Raymond Poincaré 92380, Garches, France. djillali.annane@aphp.fr. 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
Critical Care Medicine / Critical Care
Critical Care Medicine   |   September 2018
Morbidity and Mortality of Crystalloids Compared to Colloids in Critically Ill Surgical Patients: A Subgroup Analysis of a Randomized Trial
Anesthesiology Newly Published on September 12, 2018. doi:10.1097/ALN.0000000000002413
Anesthesiology Newly Published on September 12, 2018. doi:10.1097/ALN.0000000000002413
Abstract

Editor’s Perspective:

What We Already Know about This Topic:

  • Whether crystalloid or colloids are preferable for treatment of hypovolemic shock in surgical patients remains unclear

What This Article Tells Us That Is New:

  • In a preplanned subgroup analysis of a previous trial, the authors compared 28-day mortality in 741 surgical patients with hypovolemic shock who were randomized to crystalloids or colloids

  • Mortality at 30 and 90 days was similar in the two groups, and colloid administration did not increase the need for dialysis

  • Colloid administration did not improve mortality but also did not cause renal injury

Background: The multicenter randomized Colloids versus Crystalloids for the Resuscitation of the Critically Ill (CRISTAL) trial was designed to test whether colloids altered mortality compared to crystalloids in the resuscitation of intensive care unit patients with hypovolemic shock. This preplanned analysis tested the same hypothesis in the subgroup of surgical patients.

Methods: The CRISTAL trial prospectively defined patients as critically ill surgical patients whenever they underwent emergency or scheduled surgery immediately before or within 24 h of intensive care unit admission and had hypovolemic shock. The primary outcome measure was death by day 28. Secondary outcome measures included death by day 90, the need for renal replacement therapy, or the need for fresh frozen plasma transfusion.

Results: There were 741 critically ill surgical patients, 356 and 385 in the crystalloid and colloid arm, respectively. Median (interquartile range) age was 66 (52 to 76) yr, and 484 (65.3%) patients were male. Surgery was unscheduled in 543 (73.3%) cases. Mortality by day 28 did not significantly differ for crystalloids 84 (23.6%) versus colloids 100 (26%; adjusted odds ratio, 0.86; 95% CI, 0.61 to 1.21; P = 0.768). Death by day 90 (111 [31.2%] vs. 122 [31.7%]; adjusted odds ratio, 0.97; 95% CI, 0.70 to 1.33; P = 0.919) did not significantly differ between groups. Renal replacement therapy was required for 42 (11.8%) patients in the crystalloids arm versus 49 (12.7%) in the colloids arm (P = 0.871).

Conclusions: The authors found no survival benefit when comparing crystalloids to colloids in critically ill surgical patients.