• Anesthesiology · Dec 2018

    Randomized Controlled Trial

    Morbidity and Mortality of Crystalloids Compared to Colloids in Critically Ill Surgical Patients: A Subgroup Analysis of a Randomized Trial.

    • Nicholas Heming, Laure Lamothe, Samir Jaber, Jean Louis Trouillet, Claude Martin, Sylvie Chevret, and Djillali Annane.
    • 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 1; 129 (6): 1149-1158.

    What We Already Know About This TopicWHAT 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.MethodsThe 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.ResultsThere 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).ConclusionsThe authors found no survival benefit when comparing crystalloids to colloids in critically ill surgical patients.

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