Morbidity and Mortality of Crystalloids Compared to Colloids in Critically Ill Surgical Patients: A Subgroup Analysis of a Randomized Trial
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Nicholas Heming1, Laure Lamothe, Samir Jaber
1From 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.).
Insights
In critically ill surgical patients with hypovolemic shock, using colloids or crystalloids for fluid resuscitation showed no significant difference in 28-day or 90-day mortality. This finding suggests neither fluid type offers a survival benefit in this patient subgroup.
Area of Science:
- Critical Care Medicine
- Surgical Resuscitation
- Fluid Therapy
Background:
- The Colloids versus Crystalloids for the Resuscitation of the Critically Ill (CRISTAL) trial evaluated fluid resuscitation strategies.
- A preplanned analysis focused on critically ill surgical patients with hypovolemic shock.
Purpose of the Study:
- To determine if colloid administration alters mortality compared to crystalloids in surgical intensive care unit patients.
- To analyze the impact of fluid type on survival and other outcomes in this specific patient population.
Main Methods:
- A subgroup analysis of the multicenter randomized CRISTAL trial.
- Inclusion criteria: critically ill surgical patients with hypovolemic shock.
- Primary outcome: 28-day mortality; Secondary outcomes: 90-day mortality, renal replacement therapy, fresh frozen plasma transfusion.
Main Results:
- 741 surgical patients were analyzed (356 crystalloid, 385 colloid).
- No significant difference in 28-day mortality (23.6% vs. 26%; P=0.768) or 90-day mortality (31.2% vs. 31.7%; P=0.919).
- Renal replacement therapy rates were similar between groups (11.8% vs. 12.7%; P=0.871).
Conclusions:
- No survival benefit was observed when comparing crystalloids to colloids in critically ill surgical patients.
- Fluid type (colloids vs. crystalloids) does not appear to impact mortality or the need for renal support in this cohort.
What We Already Know About This Topic:
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.
Methods:
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.
Results:
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).
Conclusions:
The authors found no survival benefit when comparing crystalloids to colloids in critically ill surgical patients.
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