Balanced crystalloid compared with balanced colloid solution using a goal-directed haemodynamic algorithm

Br J Anaesth. 2013 Feb;110(2):231-40. doi: 10.1093/bja/aes377. Epub 2012 Oct 30.


Background: Controversy exists regarding the optimal i.v. fluids for use with a goal-directed haemodynamic algorithm.

Methods: In a double-blind pilot study, we randomly assigned 50 patients with primary ovarian cancer undergoing cytoreductive surgery to receive either balanced crystalloid or balanced starch (HES, 130/0.4, 6%) solutions up to the dose limit (50 ml kg(-1)). Fluids were administered to optimize stroke volume measured by oesophageal Doppler within a goal-directed haemodynamic algorithm.

Results: Baseline subject characteristics were similar in both groups. The balanced HES solution maintained stroke volume (P=0.012) better with administration of less fluid. Subjects in the colloid group reached the dose limits of the study medication less frequently (92% vs 62%, P=0.036) and later (2:26 vs 3:33 h, P=0.006) and also required less transfusion of fresh-frozen plasma units (6.0 vs 3.5 units, P=0.035) compared with the crystalloid group. Intra- and postoperative urine output and perioperative plasma levels of creatinine and neutrophil gelatinase-associated lipocalin as renal injury marker were similar in both groups. No differences in the length of intensive care unit and hospital stay were found.

Conclusions: Using a goal-directed haemodynamic algorithm to optimize stroke volume, a balanced HES solution is associated with better haemodynamic stability and reduced need for fresh-frozen plasma. There were no signs of renal impairment by colloid solutions when fluid administration is targeted to optimize cardiac preload.

Publication types

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

MeSH terms

  • Algorithms*
  • Blood Pressure / drug effects
  • Blood Pressure / physiology
  • Cardiotonic Agents / therapeutic use
  • Crystalloid Solutions
  • Double-Blind Method
  • Endpoint Determination
  • Fluid Therapy
  • Hemodynamics / drug effects
  • Hemodynamics / physiology*
  • Humans
  • Hydroxyethyl Starch Derivatives / therapeutic use*
  • Intraoperative Period
  • Isotonic Solutions / therapeutic use*
  • Length of Stay
  • Patient Selection
  • Perfusion
  • Pharmaceutical Solutions
  • Pilot Projects
  • Plasma Substitutes / therapeutic use*
  • Stroke Volume / drug effects
  • Stroke Volume / physiology
  • Vasoconstrictor Agents / therapeutic use


  • Cardiotonic Agents
  • Crystalloid Solutions
  • Hydroxyethyl Starch Derivatives
  • Isotonic Solutions
  • Pharmaceutical Solutions
  • Plasma Substitutes
  • Vasoconstrictor Agents