Morbidity and Mortality of Crystalloids Compared to Colloids in Critically Ill Surgical Patients
| Autor: | Nicholas Heming, Sylvie Chevret, Djillali Annane, Jean-Louis Trouillet, Claude Martin, Laure Lamothe, Samir Jaber |
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| Rok vydání: | 2018 |
| Předmět: |
Resuscitation
business.industry medicine.medical_treatment Subgroup analysis Odds ratio Intensive care unit 3. Good health law.invention 03 medical and health sciences 0302 clinical medicine Anesthesiology and Pain Medicine Randomized controlled trial 030202 anesthesiology Interquartile range law Anesthesia Medicine 030212 general & internal medicine Renal replacement therapy business Prospective cohort study |
| Zdroj: | Anesthesiology. 129:1149-1158 |
| ISSN: | 0003-3022 |
| Popis: | Editor’s Perspective What We Already Know about This Topic What 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. Methods The 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. Results There 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). Conclusions The authors found no survival benefit when comparing crystalloids to colloids in critically ill surgical patients. |
| Databáze: | OpenAIRE |
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