Department of Anesthesia, General Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria; the Outcomes Research Consortium, Cleveland, Ohio.
the Departments of Quantitative Health Sciences and Outcomes Research, Cleveland Clinic, Cleveland, Ohio.
Anesthesiology. 2022 Jan 1;136(1):127-137. doi: 10.1097/ALN.0000000000004040.
Colloids are thought to sustain blood pressure and cardiac index better than crystalloids. However, the relative effects of intraoperative hydroxyethyl starch and crystalloid administration on the cardiac index and blood pressure remain unclear. This study therefore tested in this subanalysis of a previously published large randomized trial the hypothesis that intraoperative goal-directed colloid administration increases the cardiac index more than goal-directed crystalloid administration. Further, the effects of crystalloid and colloid boluses on blood pressure were evaluated.
This planned subanalysis of a previous trial analyzed data from 973 patients, of whom 480 were randomized to colloids and 493 were randomized to crystalloids. Fluid administration was guided by esophageal Doppler. The primary outcome was the time-weighted average cardiac index during surgery between the colloid and crystalloid group. The secondary outcomes were the cardiac index just after bolus administration, time elapsed between boluses, and the average real variability during surgery. The study recorded cardiac index, corrected flow time, and blood pressure at 10-min intervals, as well as before and after each bolus.
Time-weighted average of cardiac index over the duration of anesthesia was only slightly greater in patients given colloid than crystalloid, with the difference being just 0.20 l · min-1 · m-2 (95% CI, 0.11 to 0.29; P < 0.001). However, the hazard for needing additional boluses was lower after colloid administration (hazard ratio [95% CI], 0.60 [0.55 to 0.66]; P < 0.001) in a frailty time-to-event model accounting for within-subject correlation. The median [quartiles] number of boluses per patient was 4 [2, 6] for colloids and 6 [3, 8] for crystalloids, with a median difference (95% CI) of -1.5 (-2 to -1; P < 0.001). The average real mean arterial pressure variability did not differ significantly between the groups (difference in means [95% CI] of -0.03 (-0.07 to 0.02) mmHg, P = 0.229).
There were not clinically meaningful differences in the cardiac index or mean pressure variability in patients given goal-directed colloid and crystalloids. As might be expected from longer intravascular dwell time, the interval between boluses was longer with colloids. However, on a case basis, the number of boluses differed only slightly. Colloids do not appear to provide substantial hemodynamic benefit.
胶体液被认为比晶体液更能维持血压和心指数。然而，术中羟乙基淀粉和晶体液的应用对心指数和血压的相对影响仍不清楚。因此，本研究在之前发表的一项大型随机试验的亚分析中检验了以下假设：术中目标导向胶体液的应用比目标导向晶体液的应用更能增加心指数。此外，还评估了晶体液和胶体液推注对血压的影响。
这是之前试验的一项计划亚分析，分析了 973 名患者的数据，其中 480 名随机分配至胶体组，493 名随机分配至晶体组。通过食管多普勒指导液体输注。主要结局为胶体组与晶体组手术期间时间加权平均心指数。次要结局为推注后即刻心指数、推注间隔时间和手术期间平均真实变异性。该研究记录了心指数、校正流量时间和血压，间隔 10 分钟记录一次，在每次推注前后记录一次。
接受胶体液的患者麻醉期间心指数的时间加权平均值仅略高于接受晶体液的患者，差值仅为 0.20 l·min-1·m-2（95%CI，0.11 至 0.29；P<0.001）。然而，在考虑到个体内相关性的脆弱性时间事件模型中，胶体液后需要额外推注的风险较低（风险比[95%CI]，0.60[0.55 至 0.66]；P<0.001）。每位患者的中位数[四分位数]推注次数为胶体液 4[2,6]，晶体液 6[3,8]，中位数差值（95%CI）为-1.5（-2 至-1；P<0.001）。两组间平均动脉压变异性的平均真实差异无显著差异（均值差异[95%CI]为-0.03[-0.07 至 0.02]mmHg，P=0.229）。
给予目标导向胶体液和晶体液的患者心指数或平均压力变异性无临床意义差异。由于胶体液的血管内停留时间较长，推注间隔时间较长。然而，在具体病例中，推注次数仅略有差异。胶体液似乎没有提供实质性的血流动力学益处。
