From the General Intensive Care Unit, Raymond Poincaré Hospital, Garches, France (N.H., L.L., D.A.) U1173 Lab Inflammation and Infection, University of Versailles SQY-Paris Saclay - INSERM, Montigny-le-Bretonneux, France (N.H., L.L., D.A.) Department of Anesthesiology and Critical Care Medicine B, Saint Eloi Hospital, Montpellier, France (S.J.) Intensive Care Unit, Institute of Cardiology, Pitié Salpêtrière Hospital, Paris, France (J.L.T.) Anaesthesiology-Emergency-Intensive Care Unit Department, AP-HM North Hospital, Marseille, France (C.M.) Biostatistical Unit, Saint Louis Hospital, Paris, France (S.C.).
Anesthesiology. 2018 Dec;129(6):1149-1158. doi: 10.1097/ALN.0000000000002413.
WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: The multicenter randomized Colloids versus Crystalloids for the Resuscitation of the Critically Ill (CRISTAL) trial was designed to test whether colloids altered mortality compared to crystalloids in the resuscitation of intensive care unit patients with hypovolemic shock. This preplanned analysis tested the same hypothesis in the subgroup of surgical patients.
The CRISTAL trial prospectively defined patients as critically ill surgical patients whenever they underwent emergency or scheduled surgery immediately before or within 24 h of intensive care unit admission and had hypovolemic shock. The primary outcome measure was death by day 28. Secondary outcome measures included death by day 90, the need for renal replacement therapy, or the need for fresh frozen plasma transfusion.
There were 741 critically ill surgical patients, 356 and 385 in the crystalloid and colloid arm, respectively. Median (interquartile range) age was 66 (52 to 76) yr, and 484 (65.3%) patients were male. Surgery was unscheduled in 543 (73.3%) cases. Mortality by day 28 did not significantly differ for crystalloids 84 (23.6%) versus colloids 100 (26%; adjusted odds ratio, 0.86; 95% CI, 0.61 to 1.21; P = 0.768). Death by day 90 (111 [31.2%] vs. 122 [31.7%]; adjusted odds ratio, 0.97; 95% CI, 0.70 to 1.33; P = 0.919) did not significantly differ between groups. Renal replacement therapy was required for 42 (11.8%) patients in the crystalloids arm versus 49 (12.7%) in the colloids arm (P = 0.871).
The authors found no survival benefit when comparing crystalloids to colloids in critically ill surgical patients.
多中心随机对照胶体与晶体复苏危重症患者（CRISTAL）试验旨在测试胶体是否会改变晶体在复苏低血容量性休克的重症监护病房患者中的死亡率。这项预先计划的分析测试了手术患者亚组中的相同假设。
CRISTAL 试验前瞻性地将患者定义为无论何时接受紧急或计划手术的重症监护病房入院前 24 小时内或在重症监护病房入院时发生低血容量性休克的危重症手术患者。主要观察终点是第 28 天的死亡。次要观察终点包括第 90 天的死亡、需要肾脏替代治疗或需要新鲜冷冻血浆输注。
共有 741 例危重症手术患者，分别有 356 例和 385 例接受晶体和胶体治疗。中位数（四分位数范围）年龄为 66（52 至 76）岁，484 例（65.3%）患者为男性。543 例（73.3%）手术为非计划性。第 28 天死亡率，晶体组 84 例（23.6%）与胶体组 100 例（26%）无显著差异（校正比值比，0.86；95%置信区间，0.61 至 1.21；P = 0.768）。第 90 天死亡率（111 例[31.2%]与 122 例[31.7%]；校正比值比，0.97；95%置信区间，0.70 至 1.33；P = 0.919）在两组之间无显著差异。晶体组有 42 例（11.8%）患者需要肾脏替代治疗，胶体组有 49 例（12.7%）（P = 0.871）。
作者发现，在危重症手术患者中，比较晶体与胶体时，没有生存获益。
