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Related Experiment Videos

Crystalloid vs. colloid resuscitation: is one better? A randomized clinical study.

R W Virgilio, C L Rice, D E Smith

    Surgery
    |February 1, 1979
    PubMed
    Summary

    Balanced salt solutions effectively resuscitate patients after abdominal aortic surgery, questioning the need for protein-containing fluids. Large volumes of Ringer's Lactate were well-tolerated when titrated to physiological endpoints.

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    Area of Science:

    • Cardiovascular Surgery
    • Critical Care Medicine
    • Fluid Resuscitation

    Background:

    • Hemodynamic resuscitation is crucial in abdominal aortic surgery.
    • The choice between protein-containing solutions and balanced salt solutions for fluid resuscitation is debated.
    • Maintaining adequate serum colloid osmotic pressure (COP) is often considered important.

    Purpose of the Study:

    • To compare the effects of Ringer's Lactate (RL) and 5% albumin in Ringer's lactate (ALB) on hemodynamic parameters and fluid balance during abdominal aortic surgery.
    • To evaluate the impact of different resuscitation fluids on serum colloid osmotic pressure (COP) and intrapulmonary shunt (Qs/Qt).

    Main Methods:

    • Prospective study of 29 patients undergoing abdominal aortic surgery.
    • Resuscitation guided by pulmonary capillary wedge pressure (PCWP), cardiac output (CO), and urine output.

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  • Measurement of COP, CO, PCWP, COP-PCWP gradient, and Qs/Qt preoperatively, intraoperatively, and for 3 days postoperatively.

    • Main Results:

    • Significantly larger fluid volumes were required with RL compared to ALB (11.3 L vs 6.2 L).
    • RL resuscitation led to a significant decrease in COP (40%) and COP-PCWP gradient, while ALB did not.
    • No significant difference in intrapulmonary shunt (Qs/Qt) was observed between groups, and it did not correlate with fluid balance or COP.
    • Pulmonary edema occurred in two patients receiving ALB, associated with normal COP and elevated PCWP.

    Conclusions:

    • Protein-containing solutions may not be necessary for acute hemodynamic resuscitation in this patient population.
    • Large volumes of balanced salt solutions (RL) are well-tolerated when titrated to physiological endpoints.
    • The study questions the routine need to maintain COP during resuscitation, highlighting potential risks of albumin in specific scenarios.