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A comparison of intraoperative goal-directed intravenous administration of crystalloid versus colloid solutions on the postoperative maximum N-terminal pro brain natriuretic peptide in patients undergoing moderate- to high-risk noncardiac surgery.

ABSTRACT: BACKGROUND:N-terminal pro brain natriuretic peptide (NT-proBNP) and troponin T are released during myocardial wall stress and/or ischemia and are strong predictors for postoperative cardiovascular complications. However, the relative effects of goal-directed, intravenous administration of crystalloid compared to colloid solutions on NT-proBNP and troponin T, especially in relatively healthy patients undergoing moderate- to high-risk noncardiac surgery, remains unclear. Thus, we evaluated in this sub-study the effect of a goal-directed crystalloid versus a goal-directed colloid fluid regimen on postoperative maximum NT-proBNP concentration. We further evaluated the incidence of myocardial injury after noncardiac surgery (MINS) between both study groups. METHODS:Thirty patients were randomly assigned to receive additional intravenous fluid boluses of 6% hydroxyethyl starch 130/0.4 and 30 patients to receive lactated Ringer's solution. Intraoperative fluid management was guided by oesophageal Doppler-according to a previously published algorithm. The primary outcome were differences in postoperative maximum NT-proBNP (maxNT-proBNP) between both groups. As our secondary outcome we evaluated the incidence of MINS between both study groups. We defined maxNT-proBNP as the maximum value measured within 2?h after surgery and on the first and second postoperative day. RESULTS:In total 56 patients were analysed. There was no significant difference in postoperative maximum NT-proBNP between the colloid group (258.7?ng/L (IQR 199.4 to 782.1)) and the crystalloid group (440.3?ng/L (IQR 177.9 to 691.2)) during the first 2 postoperative days (P?=?0.29). Five patients in the colloid group and 7 patients in the crystalloid group developed MINS (P?=?0.75). CONCLUSIONS:Based on this relatively small study goal-directed colloid administration did not decrease postoperative maxNT-proBNP concentration as compared to goal-directed crystalloid administration. TRIAL REGISTRATION:ClinicalTrials.gov ( NCT01195883 ) Registered on 6th September 2010.

SUBMITTER: Reiterer C

PROVIDER: S-EPMC7405415 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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A comparison of intraoperative goal-directed intravenous administration of crystalloid versus colloid solutions on the postoperative maximum N-terminal pro brain natriuretic peptide in patients undergoing moderate- to high-risk noncardiac surgery.

Reiterer Christian C Kabon Barbara B Taschner Alexander A Zotti Oliver O Kurz Andrea A Fleischmann Edith E

BMC anesthesiology 20200804 1

<h4>Background</h4>N-terminal pro brain natriuretic peptide (NT-proBNP) and troponin T are released during myocardial wall stress and/or ischemia and are strong predictors for postoperative cardiovascular complications. However, the relative effects of goal-directed, intravenous administration of crystalloid compared to colloid solutions on NT-proBNP and troponin T, especially in relatively healthy patients undergoing moderate- to high-risk noncardiac surgery, remains unclear. Thus, we evaluated ...[more]

PMID: 32753064

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Project description:BackgroundIntravenous crystalloid solutions are administered commonly for critically ill patients. We performed this meta-analysis of randomized trials with trial sequential analysis (TSA) to evaluate effects of chloride content of intravenous crystalloid solutions on clinical outcomes among critically ill adult patients.MethodsElectronic databases were searched up to June 1, 2018, for randomized trials of use of balanced crystalloids versus 0.9% saline solutions in critically ill adult patients. The outcome variables included mortality, renal outcomes, serum content alterations and organ function. Subgroup analysis was conducted according to patient settings, types or volume of crystalloid fluid, or among sepsis versus non-sepsis, TBI versus non-TBI or subpopulations by the categories of baseline kidney function. Random errors were evaluated by trial sequential analysis.ResultsEight studies with 19,301 patients were analyzed. A trend of in-hospital survival benefit with no statistical difference could be observed with balanced crystalloids compared with 0.9% saline (RR 0.92, 95% CI 0.85-1.0, p?=?0.06). The use of balanced crystalloid solutions was associated with longer RRT-free days (SMD 0.09, 95% CI 0.06-0.12, p?<?0.001), less risk of increase in serum concentrations of chloride (SMD -?1.23, 95% CI -?1.59 to -?0.87, p?<?0.001) and sodium (SMD -?1.28, 95% CI -?1.65 to -?0.92, p?<?0.001), less risk of decline in serum base deficit (SMD -?0.58, 95% CI -?0.98 to -?0.18, p?=?0.004), longer ventilator-free days (SMD 0.08, 95% CI 0.05-0.11, p?<?0.001) and vasopressor-free days (SMD 0.04, 95% CI 0.00-0.07, p?=?0.02). Subgroup analysis showed that balanced crystalloid solutions were associated with a reduced in-hospital mortality rate among septic patients (RR 0.86, 95% CI 0.75-0.98; p?=?0.02) and non-traumatic brain injury patients (RR 0.90, 95% CI 0.82-0.99, p?=?0.02), while the TSA results indicated a larger sample size is still in need.ConclusionsLimited evidence supported statistical survival benefit with balanced crystalloid solutions, while it benefited in reducing organ support duration and fluctuations in serum electrolyte and base excess and was associated with decreased in-hospital mortality in subpopulation with sepsis and non-TBI. Large-scale rigorous randomized trials with better designs are needed to provide robust evidence for clinical management. Trial registration The protocol for this meta-analysis was registered on PROSPERO: International prospective register of systematic reviews (CRD42018102661), https://www.crd.york.ac.uk/prospero/#recordDetails.

Dataset Information

A comparison of intraoperative goal-directed intravenous administration of crystalloid versus colloid solutions on the postoperative maximum N-terminal pro brain natriuretic peptide in patients undergoing moderate- to high-risk noncardiac surgery.

Publications

A comparison of intraoperative goal-directed intravenous administration of crystalloid versus colloid solutions on the postoperative maximum N-terminal pro brain natriuretic peptide in patients undergoing moderate- to high-risk noncardiac surgery.

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