The effect of intraoperative goal-directed crystalloid versus colloid administration on perioperative inflammatory markers - a substudy of a randomized controlled trial

Mina Obradovic, Andrea Kurz, Barbara Kabon, Georg Roth, Oliver Kimberger, Oliver Zotti, Ahamed Bayoumi, Christian Reiterer, Anton Stift, Edith Fleischmann, Mina Obradovic, Andrea Kurz, Barbara Kabon, Georg Roth, Oliver Kimberger, Oliver Zotti, Ahamed Bayoumi, Christian Reiterer, Anton Stift, Edith Fleischmann

Abstract

Background: Excessive perioperative fluid administration may result in iatrogenic endothelial dysfunction and tissue edema, transducing inflammatory markers into the bloodstream. Colloids remain longer in the circulation, requiring less volume to reach similar hemodynamic endpoints compared to crystalloids. Thus, we tested the hypothesis that a goal-directed colloid regimen attenuates the inflammatory response compared to a goal-directed crystalloid regime.

Methods: Patients undergoing moderate- to high-risk open abdominal surgery were randomly assigned to goal-directed lactated Ringer's solution (n = 58) or a hydroxyethyl starch 6% 130/0.4 (n = 62) fluid regimen. Our primary outcome was perioperative levels of pro- and anti-inflammatory cytokines. Secondary outcome was perioperative levels of white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT) and lipopolysaccharide-binding protein (LBP). Measurements were performed preoperatively, immediate postoperatively, on postoperative day one, two and four.

Results: The areas under the curve of Interleukin (IL) 6 (p = 0.60), IL 8 (p = 0.46), IL 10 (p = 0.68) and tumor necrosis factor α (p = 0.47) levels did not differ significantly between the groups. WBC, CRP and PCT values were also comparable. LBP, although significantly higher in the crystalloid group, remained in the normal range. Patients assigned to crystalloids received a median (IQR) amount of 3905 mL (2880-5288) of crystalloid. Patients assigned to colloids received 1557 mL (1207-2116) of crystalloid and 1250 mL (750-1938) of colloid.

Conclusion: Cytokine and inflammatory marker levels did not differ between goal-directed crystalloid and colloid administration after moderate to high-risk abdominal surgery.

Trial registration: ClinicalTrials.gov ( NCT00517127 ). Registered 16th August 2007.

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
CONSORT 2010 Patient flow chart
Fig. 2
Fig. 2
a-d: Pro- and anti-inflammatory cytokines IL 6, IL 8, IL 10 and TNF α over time. 2 A: IL 6, 2 B: IL 8, 2 C: IL 10 and 2 D: TNF α. Data are presented as medians (IQR). Abbreviations: IL – interleukin, TNF α – tumor necrosis factor alpha, POD – postoperative day
Fig. 3
Fig. 3
a-d: Inflammatory markers WBC, CRP, PCT and LBP over time. a: WBC, b: CRP, c: PCT and d: LBP. Data are presented as medians (IQR). Abbreviations: WBC – white blood cells, CRP – C-reactive protein, PCT – procalcitonin, LBP – lipopolysaccharide-binding protein, POD – postoperative day. ★ represents significant difference in LBP in the immediate postoperative period between the crystalloid and the colloid group (P = 0.38)

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