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

• Published in: BMJ open Vol. 7; no. 10; p. e016736
• Main Authors: Heming, Nicholas, Elatrous, Souheil, Jaber, Samir, Dumenil, Anne Sylvie, Cousson, Joël, Forceville, Xavier, Kimmoun, Antoine, Trouillet, Jean Louis, Fichet, Jérôme, Anguel, Nadia, Darmon, Michael, Martin, Claude, Chevret, Sylvie, Annane, Djillali
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.10.2017; BMJ Publishing Group
• Subjects: Africa, Northern; Aged; Blood pressure; Canada; Catheters; Clinical trials; Colloids - therapeutic use; Coma; Critical Illness - therapy; Crystalloid Solutions; Europe; Evidence-based medicine; Female; Fluid Therapy - methods; Fluids; Heart Rate; Hemodynamics; Human health and pathology; Humans; Intensive Care; Intensive Care Units; Isotonic Solutions - therapeutic use; Kidneys; Life Sciences; Male; Middle Aged; Mortality; Patients; Physiology; Pulmonary arteries; Resuscitation - methods; Sepsis; Shock - physiopathology; Shock - therapy; Veins & arteries; fluid resuscitation; colloid; pulmonary artery catheter; intensive care unit (icu); crystalloid
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2017-016736

ObjectiveTo compare the haemodynamic effect of crystalloids and colloids during acute severe hypovolaemic shock.DesignExploratory subgroup analysis of a multicentre randomised controlled trial (Colloids Versus Crystalloids for the Resuscitation of the Critically Ill, CRISTAL, ClinicalTrials.gov NCT00318942).SettingCRISTAL was conducted in intensive care units in Europe, North Africa and Canada.ParticipantsCurrent 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.InterventionCrystalloids versus colloids for fluid resuscitation in hypovolaemic shock.Outcome measuresHaemodynamic data were collected at the time of randomisation and subsequently on days 1, 2, 3, 4, 5, 6 and 7.ResultsMedian 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.ConclusionsDuring 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.