Key result
Fluid challenges with 6% hydroxyethyl starch or 5% albumin resulted in significantly greater increases in plasma volume (7.3% and 6.3%, respectively) compared to bicarbonate Ringer's solution (1.0%) 30 minutes after administration during major abdominal surgery.
Why the study?
The volume effect of iso-oncotic colloid is supposedly larger than crystalloid, but such differences depend on clinical context.
Does 6% hydroxyethyl starch or 5% albumin improve plasma volume and hemodynamic effects compared to bicarbonate Ringer's solution in patients undergoing major abdominal surgery?
Observational (n=65)
No
Does 6% hydroxyethyl starch or 5% albumin improve plasma volume and hemodynamic effects compared to bicarbonate Ringer's solution in patients undergoing major abdominal surgery?
Absolute Event Rate: 7.3% vs 1%
p-value: p=<0.05
In patients undergoing major abdominal surgery, fluid challenges with 6% hydroxyethyl starch or 5% albumin resulted in significantly larger volume and hemodynamic effects compared to bicarbonate Ringer's solution.
Colloids yielded larger plasma volume expansion and SVI response than crystalloid during abdominal surgery; supports hypothesis-generating comparisons but should not yet change practice.
BACKGROUND: The volume effect of iso-oncotic colloid is supposedly larger than crystalloid, but such differences are dependent on clinical context. The purpose of this single center observational study was to compare the volume and hemodynamic effects of crystalloid solution and colloid solution during surgical manipulation in patients undergoing major abdominal surgery. METHODS: Subjects undergoing abdominal surgery for malignancies with intraoperative goal-directed fluid management were enrolled in this observational study. Fluid challenges consisted with 250 ml of either bicarbonate Ringer solution, 6% hydroxyethyl starch or 5% albumin were provided to maintain optimal stroke volume index. Hematocrit derived-plasma volume and colloid osmotic pressure was determined immediately before and 30 min after the fluid challenge. Data were expressed as median (IQR) and statistically compared with Kruskal-Wallis test. RESULTS: One hundred thirty-nine fluid challenges in 65 patients were analyzed. Bicarbonate Ringer solution, 6% hydroxyethyl starch and 5% albumin were administered in 42, 49 and 48 instances, respectively. Plasma volume increased 7.3 (3.6-10.0) % and 6.3 (1.4-8.8) % 30 min after the fluid challenge with 6% hydroxyethyl starch and 5% albumin and these values are significantly larger than the value with bicarbonate Ringer solution (1.0 (- 2.7-2.3) %) Colloid osmotic pressure increased 0.6 (0.2-1.2) mmHg after the fluid challenge with 6% hydroxyethyl starch and 0.7(0.2-1.3) mmHg with 5% albumin but decreased 0.6 (0.2-1.2) mmHg after the fluid challenge with bicarbonate Ringer solution. The area under the curve of stroke volume index after fluid challenge was significantly larger after 6% hydroxyethyl starch or 5% albumin compared to bicarbonate Ringer solution. CONCLUSIONS: Fluid challenge with 6% hydroxyethyl starch and 5% albumin showed significantly larger volume and hemodynamic effects compared to bicarbonate Ringer solution during gastrointestinal surgery. TRIAL REGISTRATION: UMIN Clinical Trial Registry UMIN000017964. Registered July 01, 2015.
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Toyoda et al. (2020) conducted an observational in Major abdominal surgery (n=65). 6% hydroxyethyl starch and 5% albumin vs. Bicarbonate Ringer's solution was evaluated on Increase in plasma volume 30 minutes after fluid challenge (p=<0.05). Fluid challenges with 6% hydroxyethyl starch or 5% albumin resulted in significantly greater increases in plasma volume (7.3% and 6.3%, respectively) compared to bicarbonate Ringer's solution (1.0%) 30 minutes after administration during major abdominal surgery.
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