Greater cardiac response of colloid than saline fluid loading in septic and non-septic critically ill patients with clinical hypovolaemia

Intensive Care Med. 2010 Apr;36(4):697-701. doi: 10.1007/s00134-010-1776-x. Epub 2010 Feb 18.


Background and objective: The haemodynamics of crystalloid and colloid fluid loading may depend on underlying disease, i.e. sepsis versus non-sepsis.

Design and setting: A single-centre, single-blinded, randomized clinical trial was carried out on 24 critically ill sepsis and 24 non-sepsis patients with clinical hypovolaemia, assigned to loading with normal saline, gelatin 4%, hydroxyethyl starch 6% or albumin 5% in a 90-min (delta) central venous pressure (CVP)-guided fluid loading protocol. Transpulmonary thermodilution was done each 30 min, yielding, among others, global end-diastolic volume and cardiac indices (GEDVI, CI).

Results: Sepsis patients had hyperdynamic hypotension in spite of myocardial depression and dilatation, and greater inotropic/vasopressor requirements than non-sepsis patients. Independent of underlying disease, CVP and GEDVI increased more after colloid than saline loading (P < 0.018), so that CI increased by about 2% after saline and 12% after colloid loading (P = 0.029). The increase in preload-recruitable stroke work was also greater with colloids and did not differ among conditions.

Conclusion: Fluid loading with colloids results in a greater linear increase in cardiac filling, output and stroke work than does saline loading, in both septic and non-septic clinical hypovolaemia, in spite of myocardial depression and presumably increased vasopermeability potentially decreasing the effects of colloid fluid loading in the former.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Albumins / therapeutic use
  • Cardiac Output
  • Chi-Square Distribution
  • Critical Illness
  • Crystalloid Solutions
  • Female
  • Fluid Therapy / methods*
  • Gelatin / therapeutic use
  • Humans
  • Hydroxyethyl Starch Derivatives / therapeutic use
  • Hypovolemia / etiology*
  • Hypovolemia / physiopathology
  • Hypovolemia / therapy*
  • Isotonic Solutions / therapeutic use
  • Male
  • Middle Aged
  • Plasma Substitutes / therapeutic use*
  • Prospective Studies
  • Saline Solution, Hypertonic / therapeutic use
  • Sepsis / complications*
  • Sepsis / physiopathology
  • Single-Blind Method
  • Statistics, Nonparametric
  • Treatment Outcome


  • Albumins
  • Crystalloid Solutions
  • Hydroxyethyl Starch Derivatives
  • Isotonic Solutions
  • Plasma Substitutes
  • Saline Solution, Hypertonic
  • Gelatin