Abstract 15026: Fluid Therapy With Synthetic Colloids In Cardiac Surgical Intensive Care Patients Is Associated With Moderately Reduced Early Fluid Need But Significantly More Acute Kidney Injury - An Analysis Of 6478 Patients.
Objectives: The type of fluid for volume therapy in patients requiring major surgery and intensive care is highly controversial. The rationale for the use of synthetic colloids is to achieve a volume-sparing effect. We previously demonstrated that synthetic colloid exposition is associated with an increased risk for acute kidney injury (AKI) in septic patients. Now, we assessed AKI and fluid need in cardiac surgical ICU patients.
Methods: Sequential analysis of 6478 patients having undergone cardiac surgery with cardiopulmonary bypass between January 2004 and April 2010. Group 1 (33%) received 6% HES 130/0.4 and crystalloids, Group 2 (36%) 4% gelatin and crystalloids. Group 3 (31%) received only crystalloids as volume therapy except for HES as standardized cardiac priming solution. Endpoints were fluid intake, AKI defined by RIFLE criteria, new need for renal replacement therapy (RRT), mortality and length of stay. Multiple logistic regression analysis was performed with RRT as independent variable.
Results: Hospital mortality was not significantly different between groups (Group 1: 4.4%, Group 2: 5.9%, Group 3: 4.9%). The average amount of total infused fluid within the first two treatment days was 39% less in Group 1 (HES) and 8% less in Group 2 (Gelatin) in comparison to the crystalloid group. However, both the rate of RRT (Group 1: 7%; Group 2: 7.4%, both p<0.05 versus Group 3: 4.8%) and RIFLE failure (Group 1: 9.2%, Group 2: 8.8%, both p<0.001 versus Group 3: 5.7%) were significantly lower in the crystalloid group. The use of HES (Odds Ratio 2.3 [95% CI: 1.1-4.7], p<0.05) and gelatin (Odds Ratio 2.8 [95% CI: 1.5-5.1], p<0.05) was an independent risk factor for RRT. Median ICU and hospital length of stay tended to be longer in Group 1 (HES).
Conclusions: Risk-benefit assessment of synthetic colloids shows only moderate volume-sparing effect but increased incidence of AKI and a higher need for RRT. These fluids should therefore be used with great caution in these patients.
- © 2011 by American Heart Association, Inc.