Barbara Kabon1, Daniel I Sessler, Andrea Kurz. 1. From the Department of Anesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria (B.K.) the Departments of Outcomes Research (D.I.S., A.K.) General Anesthesiology (A.K.), Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio. Cleveland Clinic, Cleveland, Ohio Cleveland Clinic, Cleveland, Ohio Cleveland Clinic, Cleveland, Ohio Cleveland Clinic, Cleveland, Ohio Cleveland Clinic, Cleveland, Ohio Cleveland Clinic, Cleveland, Ohio Cleveland Clinic, Cleveland, Ohio Cleveland Clinic, Cleveland, Ohio Cleveland Clinic, Cleveland, Ohio Cleveland Clinic, Cleveland, Ohio Cleveland Clinic, Cleveland, Ohio Cleveland Clinic, Cleveland, Ohio Cleveland Clinic, Cleveland, Ohio Cleveland Clinic, Cleveland, Ohio Cleveland Clinic, Cleveland, Ohio Cleveland Clinic, Cleveland, Ohio Cleveland Clinic, Cleveland, Ohio Cleveland Clinic, Cleveland, Ohio Cleveland Clinic, Cleveland, Ohio Medical University of Vienna, Vienna, Austria Medical University of Vienna, Vienna, Austria Medical University of Vienna, Vienna, Austria Medical University of Vienna, Vienna, Austria Medical University of Vienna, Vienna, Austria Medical University of Vienna, Vienna, Austria Medical University of Vienna, Vienna, Austria Medical University of Vienna, Vienna, Austria Medical University of Vienna, Vienna, Austria Medical University of Vienna, Vienna, Austria Medical University of Vienna, Vienna, Austria Medical University of Vienna, Vienna, Austria Medical University of Vienna, Vienna, Austria Medical University of Vienna, Vienna, Austria Medical University of Vienna, Vienna, Austria Medical University of Vienna, Vienna, Austria Medical University of Vienna, Vienna, Austria Ohio State University, Columbus, Ohio.
Abstract
BACKGROUND:Crystalloid solutions leave the circulation quickly, whereas colloids remain for hours, thus promoting hemodynamic stability. However, colloids are expensive and promote renal toxicity in critical care patients. This study tested the hypothesis that goal-directed colloid administration during elective abdominal surgery decreases 30-day major complications more than goal-directed crystalloid administration. METHODS: In this parallel-arm double-blinded multicenter randomized trial, adults having moderate- to high-risk open and laparoscopically assisted abdominal surgery with general anesthesia were randomly assigned to Doppler-guided intraoperative volume replacement with 6% hydroxyethyl starch 130/0.4 (n = 523) or lactated Ringer's solution (n = 534). The primary outcome was a composite of serious postoperative cardiac, pulmonary, infectious, gastrointestinal, renal, and coagulation complications that were assessed with a generalized estimating equation multivariate model. The primary safety outcome was a change in serum creatinine concentration up to 6 months postoperatively, compared to baseline concentrations. RESULTS:A total of 1,057 patients were included in the analysis. Patients assigned to crystalloid received a median [quartile 1, quartile 3] amount of 3.2 l [2.3, 4.4] of crystalloid, and patients assigned to colloid received 1.0 l [0.5, 1.5] of colloid and 1.8 l [1.2, 2.4] of crystalloid. The estimated intention-to-treat common effect relative risk for the primary composite was 0.90 for colloids versus crystalloids (95% CI: 0.65 to 1.23, P = 0.51), and 18% (91 of 523) of colloid patients and 20% (103 of 534) of crystalloid patients incurred at least one component of the primary outcome composite. There was no evidence of renal toxicity at any time. CONCLUSIONS:Doppler-guided intraoperative hydroxyethyl starch administration did not significantly reduce a composite of serious complications. However, there was also no indication of renal or other toxicity.
RCT Entities:
BACKGROUND: Crystalloid solutions leave the circulation quickly, whereas colloids remain for hours, thus promoting hemodynamic stability. However, colloids are expensive and promote renal toxicity in critical care patients. This study tested the hypothesis that goal-directed colloid administration during elective abdominal surgery decreases 30-day major complications more than goal-directed crystalloid administration. METHODS: In this parallel-arm double-blinded multicenter randomized trial, adults having moderate- to high-risk open and laparoscopically assisted abdominal surgery with general anesthesia were randomly assigned to Doppler-guided intraoperative volume replacement with 6% hydroxyethyl starch 130/0.4 (n = 523) or lactated Ringer's solution (n = 534). The primary outcome was a composite of serious postoperative cardiac, pulmonary, infectious, gastrointestinal, renal, and coagulation complications that were assessed with a generalized estimating equation multivariate model. The primary safety outcome was a change in serum creatinine concentration up to 6 months postoperatively, compared to baseline concentrations. RESULTS: A total of 1,057 patients were included in the analysis. Patients assigned to crystalloid received a median [quartile 1, quartile 3] amount of 3.2 l [2.3, 4.4] of crystalloid, and patients assigned to colloid received 1.0 l [0.5, 1.5] of colloid and 1.8 l [1.2, 2.4] of crystalloid. The estimated intention-to-treat common effect relative risk for the primary composite was 0.90 for colloids versus crystalloids (95% CI: 0.65 to 1.23, P = 0.51), and 18% (91 of 523) of colloid patients and 20% (103 of 534) of crystalloid patients incurred at least one component of the primary outcome composite. There was no evidence of renal toxicity at any time. CONCLUSIONS: Doppler-guided intraoperative hydroxyethyl starch administration did not significantly reduce a composite of serious complications. However, there was also no indication of renal or other toxicity.
Authors: Vittoria Arslan-Carlon; Kay See Tan; Guido Dalbagni; Alessia C Pedoto; Harry W Herr; Bernard H Bochner; Eugene K Cha; Timothy F Donahue; Mary Fischer; S Machele Donat Journal: Anesthesiology Date: 2020-08 Impact factor: 7.892
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Authors: Mina Obradovic; Andrea Kurz; Barbara Kabon; Georg Roth; Oliver Kimberger; Oliver Zotti; Ahamed Bayoumi; Christian Reiterer; Anton Stift; Edith Fleischmann Journal: BMC Anesthesiol Date: 2020-08-21 Impact factor: 2.217
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Authors: Christian Reiterer; Barbara Kabon; Markus Falkner von Sonnenburg; Patrick Starlinger; Alexander Taschner; Oliver Zotti; Julius Goshin; Gregor Drlicek; Edith Fleischmann Journal: Trials Date: 2020-05-12 Impact factor: 2.279
Authors: Christian Reiterer; Barbara Kabon; Alexander Taschner; Oliver Zotti; Andrea Kurz; Edith Fleischmann Journal: BMC Anesthesiol Date: 2020-08-04 Impact factor: 2.217