Fluids after cardiac surgery: A pilot study of the use of colloids versus crystalloids

Objectives: To determine whether a starch solution for volume resuscitation in a flow-based protocol improves circulatory status better than a crystalloid solution, as defined by the need for catecholamines in patients the morning after cardiac surgery, and whether this can be performed without increased morbidity. Design: Concealed, randomized, double-blind, controlled trial. Participants: Two hundred sixty-two patients who underwent cardiac surgery at a tertiary care hospital. Interventions: Based on predefined criteria indicating a need for fluids, and a nurse-delivered algorithm that used central venous pressure and cardiac index obtained from a pulmonary artery catheter, patients were allocated to receive 250-mL boluses of 0.9% saline or a 250-molecular weight 10% solution of pentastarch. Results: Two hundred thirty-seven patients received volume boluses: 119 hydroxyethyl starches and 118 saline. Between 8: 00 AM and 9: 00 AM the morning after surgery, 13 (10.9%) of hydroxy-ethyl starch patients and 34 (28.8%) saline patients were using catecholamines (p=.001). Hydroxyethyl starch patients had less pneumonia and mediastinal infections (p=.03) and less cardiac pacing (p=.03). There were two deaths in each group. There was no difference in the daily creatinine, development of RIFLE risk criteria during hospital stay, or new dialysis. The numbers and volumes of packed red blood cells were similar in the two groups, but more hydroxyethyl starch patients received plasma transfusions (p=.05). Conclusions: Use of a colloid solution for volume resuscitation in a nurse-delivered flow-based algorithm, which included a pulmonary artery catheter, significantly improved hemodynamic status, an important factor for readiness for discharge from the intensive care unit. (Crit Care Med 2010; 38: 2117-2124)