Intraoperative Goal-directed Balanced Crystalloid versus Colloid

Another piece for the perpetual puzzle as to the harms and/or benefits of colloids vs. crystalloids.

The potential serious kidney injury and mortality using Hydroxyethyl Starch reported in critical illness are not always replicated in the intraoperative setting.

In this study in abdominal surgery, the primary outcome was a composite of serious postoperative cardiac, pulmonary, infectious, gastrointestinal, renal, and coagulation complications. Creatinine at 6 months was assessed.

Lactated Ringers or Hydroxyethyl Starch were given in a goal directed manner using esophageal Doppler based on stroke volume and corrected aortic flow time.

“Doppler-guided intraoperative hydroxyethyl starch administration did not reduce composites of serious complications. Nor did hydroxyethyl starch reduce the duration of hospitalization, but there was also no indication of renal or other toxicity”.

No clear reason to use Hydroxyethyl Starch is apparent, in view of the greater cost.

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