Haemodynamic response to crystalloids or colloids in shock: an exploratory subgroup analysis of a randomised controlled trial

Nicholas Heming, Souheil Elatrous, Samir Jaber, Anne Sylvie Dumenil, Joël Cousson, Xavier Forceville, Antoine Kimmoun, Jean Louis Trouillet, Jérôme Fichet, Nadia Anguel, Michael Darmon, Claude Martin, Sylvie Chevret, Djillali Annane, CRISTAL Investigators, Nicholas Heming, Souheil Elatrous, Samir Jaber, Anne Sylvie Dumenil, Joël Cousson, Xavier Forceville, Antoine Kimmoun, Jean Louis Trouillet, Jérôme Fichet, Nadia Anguel, Michael Darmon, Claude Martin, Sylvie Chevret, Djillali Annane, CRISTAL Investigators

Abstract

Objective: To compare the haemodynamic effect of crystalloids and colloids during acute severe hypovolaemic shock.

Design: Exploratory subgroup analysis of a multicentre randomised controlled trial (Colloids Versus Crystalloids for the Resuscitation of the Critically Ill, CRISTAL, ClinicalTrials.gov NCT00318942).

Setting: CRISTAL was conducted in intensive care units in Europe, North Africa and Canada.

Participants: Current analysis included all patients who had a pulmonary artery catheter in place at randomisation. 220 patients (117 received crystalloids vs 103 colloids) underwent pulmonary artery catheterisation.

Intervention: Crystalloids versus colloids for fluid resuscitation in hypovolaemic shock.

Outcome measures: Haemodynamic data were collected at the time of randomisation and subsequently on days 1, 2, 3, 4, 5, 6 and 7.

Results: Median cumulative volume of fluid administered during the first 7 days was higher in the crystalloids group than in the colloids group (3500 (2000-6000) vs 2500 (1000-4000) mL, p=0.01). Patients in the colloids arm exhibited a lower heart rate over time compared with those allocated to the crystalloids arm (p=0.014). There was no significant difference in Cardiac Index (p=0.053), mean blood pressure (p=0.4), arterial lactates (p=0.9) or global Sequential Organ Failure Assessment score (p=0.3) over time between arms.

Conclusions: During acute severe hypovolaemic shock, patients monitored by a pulmonary artery catheter achieved broadly similar haemodynamic outcomes, using lower volumes of colloids than crystalloids. The heart rate was lower in the colloids arm.

Keywords: colloid; crystalloid; fluid resuscitation; intensive care unit (icu); pulmonary artery catheter.

Conflict of interest statement

Competing interests: None declared.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1
Figure 1
Box plot showing heart rate distribution over the first 7 days following randomisation in both arms. The horizontal line in the box indicates the median value, whereas the lines at the top and bottom of the box indicate IQR. Day 0, day of randomisation. bpm, beats/min.
Figure 2
Figure 2
Box plot showing Cardiac Index distribution over the first 7 days following randomisation in both arms. The horizontal line in the box indicates the median value, whereas the lines at the top and bottom of the box indicate IQR. Day 0, day of randomisation.
Figure 3
Figure 3
Box plot showing the rate–pressure product distribution over the first 7 days following randomisation in both arms. The horizontal line in the box indicates the median value, whereas the lines at the top and bottom of the box indicate IQR. Day 0, day of randomisation.

References

    1. Myburgh JA, Mythen MG. Resuscitation fluids. N Engl J Med 2013;369:1243–51. 10.1056/NEJMra1208627
    1. Guyton AC, Hall JE. Textbook Of Medical Physiology. Philadelphia: Saunders, 2005.
    1. Myburgh JA. Fluid resuscitation in acute medicine: what is the current situation? J Intern Med 2015;277:58–68. 10.1111/joim.12326
    1. Scheingraber S, Rehm M, Sehmisch C, et al. . Rapid saline infusion produces hyperchloremic acidosis in patients undergoing gynecologic surgery. Anesthesiology 1999;90:1265–70. 10.1097/00000542-199905000-00007
    1. Orbegozo Cortés D, Rayo Bonor A, Vincent JL. Isotonic crystalloid solutions: a structured review of the literature. Br J Anaesth 2014;112:968–81. 10.1093/bja/aeu047
    1. Yunos NM, Bellomo R, Hegarty C, et al. . Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults. JAMA 2012;308:1566–72. 10.1001/jama.2012.13356
    1. Verheij J, van Lingen A, Beishuizen A, et al. . Cardiac response is greater for colloid than saline fluid loading after cardiac or vascular surgery. Intensive Care Med 2006;32:1030–8. 10.1007/s00134-006-0195-5
    1. Trof RJ, Sukul SP, Twisk JW, et al. . Greater cardiac response of colloid than saline fluid loading in septic and non-septic critically ill patients with clinical hypovolaemia. Intensive Care Med 2010;36:697–701. 10.1007/s00134-010-1776-x
    1. Wiedermann CJ, Bellomo R, Perner A. Is the literature inconclusive about the harm from HES? No. Intensive Care Med 2016. (Published Online First: 23 March 2016). 10.1007/s00134-016-4275-x
    1. Ertmer C, Annane D, Van Der Linden P. Is the literature inconclusive about the harm from HES? Yes. Intensive Care Med 2016. (Published Online First: 23 March 2016). 10.1007/s00134-016-4278-7
    1. Schetz M, Shaw AD, Vincent J-L. Is the literature inconclusive about the harm of HES? We are not sure. Intensive Care Med;120 10.1007/s00134-016-4329-0
    1. Perner A, Haase N, Guttormsen AB, et al. . Hydroxyethyl starch 130/0.42 versus Ringer’s acetate in severe sepsis. N Engl J Med 2012;367:124–34. 10.1056/NEJMoa1204242
    1. Myburgh JA, Finfer S, Bellomo R, et al. . Hydroxyethyl starch or saline for fluid resuscitation in intensive care. N Engl J Med 2012;367:1901–11. 10.1056/NEJMoa1209759
    1. Finfer S, Bellomo R, Boyce N, et al. . A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med 2004;350:2247–56. 10.1056/NEJMoa040232
    1. Caironi P, Tognoni G, Masson S, et al. . Albumin replacement in patients with severe sepsis or septic shock. N Engl J Med 2014;370:1412–21. 10.1056/NEJMoa1305727
    1. Brunkhorst FM, Engel C, Bloos F, et al. . Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med 2008;358:125–39. 10.1056/NEJMoa070716
    1. Annane D, Siami S, Jaber S, et al. . Effects of fluid resuscitation with colloids vs crystalloids on mortality in critically ill patients presenting with hypovolemic shock: the CRISTAL randomized trial. JAMA 2013;310:1809–17. 10.1001/jama.2013.280502
    1. Vincent JL, Pinsky MR, Sprung CL, et al. . The pulmonary artery catheter: in medio virtus. Crit Care Med 2008;36:3093–6. 10.1097/CCM.0b013e31818c10c7
    1. McCabe WR, Jackson GG, Gram-negative bacteremia: I. Etiology and ecology. Arch Intern Med 1962;110:847–55.
    1. Knaus WA, Zimmerman JE, Wagner DP, et al. . APACHE-acute physiology and chronic health evaluation: a physiologically based classification system. Crit Care Med 1981;9:591–7. 10.1097/00003246-198108000-00008
    1. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974;2:81–4.
    1. Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA 1993;270:2957–63. 10.1001/jama.1993.03510240069035
    1. Vincent JL, Moreno R, Takala J, et al. . The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996;22:707–10.
    1. Dellinger RP, Levy MM, Rhodes A, et al. . Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 2013;41:580–637.
    1. Laird NM, Ware JH. Random-effects models for longitudinal data. Biometrics 1982;38:963–74. 10.2307/2529876
    1. Dellinger RP, Levy MM, Rhodes A, et al. . Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med 2013;41:580–637. 10.1097/CCM.0b013e31827e83af
    1. Mann DL, Zipes DP, Libby P, et al. . Braunwald’s heart disease: a textbook of cardiovascular medicine. Elsevier Health Sciences 2014.
    1. Parker MM, Shelhamer JH, Natanson C, et al. . Serial cardiovascular variables in survivors and nonsurvivors of human septic shock: heart rate as an early predictor of prognosis. Crit Care Med 1987;15:923–9.
    1. Sander O, Welters ID, Foëx P, et al. . Impact of prolonged elevated heart rate on incidence of major cardiac events in critically ill patients with a high risk of cardiac complications. Crit Care Med 2005;33:81–8. 10.1097/01.CCM.0000150028.64264.14
    1. Orbegozo Cortés D, Gamarano Barros T, Njimi H, et al. . Crystalloids versus colloids: exploring differences in fluid requirements by systematic review and meta-regression. Anesth Analg 2015;120:389–402. 10.1213/ANE.0000000000000564
    1. Wiedemann HP, Wheeler AP, Bernard GR, et al. . Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wiedemann HP. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med 2006;354:2564–75.
    1. Malbrain ML, Marik PE, Witters I, et al. . Fluid overload, de-resuscitation, and outcomes in critically ill or injured patients: a systematic review with suggestions for clinical practice. Anaesthesiol Intensive Ther 2014;46:361–80. 10.5603/AIT.2014.0060
    1. Boyd JH, Forbes J, Nakada TA, et al. . Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med 2011;39:259–65. 10.1097/CCM.0b013e3181feeb15
    1. US Food and Drug Administration. Hydroxyethyl starch solutions: FDA safety communication - boxed warning on increased mortality and severe renal injury and risk of bleeding. (accessed 7 Apr 2015).
    1. European Medicines Agency. PRAC confirms that hydroxyethyl-starch solutions (HES) should no longer be used in patients with sepsis or burn injuries or in critically ill patients.2013.

Source: PubMed

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