Effects of goal-directed crystalloid vs. colloid fluid therapy on microcirculation during free flap surgery: A randomised clinical trial

Ildikó László, Ágnes Janovszky, András Lovas, Viktória Vargán, Nándor Öveges, Tamás Tánczos, András Mikor, Domonkos Trásy, Zoltán Lóderer, József Piffkó, Andrea Szabó, Z. Molnár

Research output: Article

Abstract

BACKGROUNDMacro, and microcirculatory effects of crystalloids and colloids are difficult to compare, because interventions to achieve haemodynamic stability seldom follow similar criteria.OBJECTIVESOur aim was to compare the effects of crystalloids and colloids on the microcirculation during free flap surgery when management was guided by detailed haemodynamic assessment.DESIGNA randomised, controlled clinical trial.SETTINGSThe investigation was performed at the University of Szeged, Hungary.PATIENTSPatients undergoing maxillofacial tumour resection and free flap reconstruction were randomised into groups treated with either intra-operative crystalloid (Ringerfundin, n = 15) or colloid (6% hydroxyethyl starch, HES, n = 15) solutions.INTERVENTIONSMacrohaemodynamics were monitored by a noncalibrated device (PulsioFlex-PULSION). Central venous oxygen saturation, venous-to-arterial PCO2-gap, lactate levels and urine output were measured hourly. Maintenance fluid was Ringerfundin (1 ml kg-1 h-1), and a multimodal, individualised, approach-based algorithm was applied to guide haemodynamic support. Hypovolaemia was treated with Ringerfundin or HES fluid boluses, respectively. The microcirculatory effects were assessed by laser-Doppler flowmetry (PeriFlux 5000 LDPM), with the probe placed on the flap and on a control area. Measurements were performed after the flap was prepared, then 1 and 12 h later.MAIN OUTCOME MEASURESThe primary end-point was microcirculatory perfusion as determined by laser-Doppler flowmetry.RESULTSThere was no difference between the groups regarding patient characteristics. Both groups remained haemodynamically stable throughout due to the use of approximately a 1.5 times higher total fluid volume in the Ringerfundin group than in the HES group: mean ± SD: 2581 ± 986 and 1803 ± 497) ml, respectively, (P = 0.011). There was no significant difference in the microcirculatory blood flow between the groups.CONCLUSIONOur results showed that when fluid management was guided by detailed haemodynamic assessment, more crystalloid than colloid was needed to maintain haemodynamic stability, but there was no difference between the effects of crystalloids and colloids on the microcirculation.TRIAL REGISTRATIONClinicalTrials.gov NCT03288051.

Original languageEnglish
Pages (from-to)592-604
Number of pages13
JournalEuropean Journal of Anaesthesiology
Volume36
Issue number8
DOIs
Publication statusPublished - aug. 1 2019

Fingerprint

Free Tissue Flaps
Fluid Therapy
Colloids
Microcirculation
Randomized Controlled Trials
Hemodynamics
Laser-Doppler Flowmetry
Hypovolemia
Hungary
Starch
Lactic Acid
Perfusion
Maintenance
crystalloid solutions
Urine
Oxygen
Equipment and Supplies
Ringerfundin
Neoplasms

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Effects of goal-directed crystalloid vs. colloid fluid therapy on microcirculation during free flap surgery : A randomised clinical trial. / László, Ildikó; Janovszky, Ágnes; Lovas, András; Vargán, Viktória; Öveges, Nándor; Tánczos, Tamás; Mikor, András; Trásy, Domonkos; Lóderer, Zoltán; Piffkó, József; Szabó, Andrea; Molnár, Z.

In: European Journal of Anaesthesiology, Vol. 36, No. 8, 01.08.2019, p. 592-604.

Research output: Article

László, I, Janovszky, Á, Lovas, A, Vargán, V, Öveges, N, Tánczos, T, Mikor, A, Trásy, D, Lóderer, Z, Piffkó, J, Szabó, A & Molnár, Z 2019, 'Effects of goal-directed crystalloid vs. colloid fluid therapy on microcirculation during free flap surgery: A randomised clinical trial', European Journal of Anaesthesiology, vol. 36, no. 8, pp. 592-604. https://doi.org/10.1097/EJA.0000000000001024
László, Ildikó ; Janovszky, Ágnes ; Lovas, András ; Vargán, Viktória ; Öveges, Nándor ; Tánczos, Tamás ; Mikor, András ; Trásy, Domonkos ; Lóderer, Zoltán ; Piffkó, József ; Szabó, Andrea ; Molnár, Z. / Effects of goal-directed crystalloid vs. colloid fluid therapy on microcirculation during free flap surgery : A randomised clinical trial. In: European Journal of Anaesthesiology. 2019 ; Vol. 36, No. 8. pp. 592-604.
@article{6f5c4e1a85c14a458543ec513798f4c5,
title = "Effects of goal-directed crystalloid vs. colloid fluid therapy on microcirculation during free flap surgery: A randomised clinical trial",
abstract = "BACKGROUNDMacro, and microcirculatory effects of crystalloids and colloids are difficult to compare, because interventions to achieve haemodynamic stability seldom follow similar criteria.OBJECTIVESOur aim was to compare the effects of crystalloids and colloids on the microcirculation during free flap surgery when management was guided by detailed haemodynamic assessment.DESIGNA randomised, controlled clinical trial.SETTINGSThe investigation was performed at the University of Szeged, Hungary.PATIENTSPatients undergoing maxillofacial tumour resection and free flap reconstruction were randomised into groups treated with either intra-operative crystalloid (Ringerfundin, n = 15) or colloid (6{\%} hydroxyethyl starch, HES, n = 15) solutions.INTERVENTIONSMacrohaemodynamics were monitored by a noncalibrated device (PulsioFlex-PULSION). Central venous oxygen saturation, venous-to-arterial PCO2-gap, lactate levels and urine output were measured hourly. Maintenance fluid was Ringerfundin (1 ml kg-1 h-1), and a multimodal, individualised, approach-based algorithm was applied to guide haemodynamic support. Hypovolaemia was treated with Ringerfundin or HES fluid boluses, respectively. The microcirculatory effects were assessed by laser-Doppler flowmetry (PeriFlux 5000 LDPM), with the probe placed on the flap and on a control area. Measurements were performed after the flap was prepared, then 1 and 12 h later.MAIN OUTCOME MEASURESThe primary end-point was microcirculatory perfusion as determined by laser-Doppler flowmetry.RESULTSThere was no difference between the groups regarding patient characteristics. Both groups remained haemodynamically stable throughout due to the use of approximately a 1.5 times higher total fluid volume in the Ringerfundin group than in the HES group: mean ± SD: 2581 ± 986 and 1803 ± 497) ml, respectively, (P = 0.011). There was no significant difference in the microcirculatory blood flow between the groups.CONCLUSIONOur results showed that when fluid management was guided by detailed haemodynamic assessment, more crystalloid than colloid was needed to maintain haemodynamic stability, but there was no difference between the effects of crystalloids and colloids on the microcirculation.TRIAL REGISTRATIONClinicalTrials.gov NCT03288051.",
author = "Ildik{\'o} L{\'a}szl{\'o} and {\'A}gnes Janovszky and Andr{\'a}s Lovas and Vikt{\'o}ria Varg{\'a}n and N{\'a}ndor {\"O}veges and Tam{\'a}s T{\'a}nczos and Andr{\'a}s Mikor and Domonkos Tr{\'a}sy and Zolt{\'a}n L{\'o}derer and J{\'o}zsef Piffk{\'o} and Andrea Szab{\'o} and Z. Moln{\'a}r",
year = "2019",
month = "8",
day = "1",
doi = "10.1097/EJA.0000000000001024",
language = "English",
volume = "36",
pages = "592--604",
journal = "European Journal of Anaesthesiology",
issn = "0265-0215",
publisher = "Lippincott Williams and Wilkins",
number = "8",

}

TY - JOUR

T1 - Effects of goal-directed crystalloid vs. colloid fluid therapy on microcirculation during free flap surgery

T2 - A randomised clinical trial

AU - László, Ildikó

AU - Janovszky, Ágnes

AU - Lovas, András

AU - Vargán, Viktória

AU - Öveges, Nándor

AU - Tánczos, Tamás

AU - Mikor, András

AU - Trásy, Domonkos

AU - Lóderer, Zoltán

AU - Piffkó, József

AU - Szabó, Andrea

AU - Molnár, Z.

PY - 2019/8/1

Y1 - 2019/8/1

N2 - BACKGROUNDMacro, and microcirculatory effects of crystalloids and colloids are difficult to compare, because interventions to achieve haemodynamic stability seldom follow similar criteria.OBJECTIVESOur aim was to compare the effects of crystalloids and colloids on the microcirculation during free flap surgery when management was guided by detailed haemodynamic assessment.DESIGNA randomised, controlled clinical trial.SETTINGSThe investigation was performed at the University of Szeged, Hungary.PATIENTSPatients undergoing maxillofacial tumour resection and free flap reconstruction were randomised into groups treated with either intra-operative crystalloid (Ringerfundin, n = 15) or colloid (6% hydroxyethyl starch, HES, n = 15) solutions.INTERVENTIONSMacrohaemodynamics were monitored by a noncalibrated device (PulsioFlex-PULSION). Central venous oxygen saturation, venous-to-arterial PCO2-gap, lactate levels and urine output were measured hourly. Maintenance fluid was Ringerfundin (1 ml kg-1 h-1), and a multimodal, individualised, approach-based algorithm was applied to guide haemodynamic support. Hypovolaemia was treated with Ringerfundin or HES fluid boluses, respectively. The microcirculatory effects were assessed by laser-Doppler flowmetry (PeriFlux 5000 LDPM), with the probe placed on the flap and on a control area. Measurements were performed after the flap was prepared, then 1 and 12 h later.MAIN OUTCOME MEASURESThe primary end-point was microcirculatory perfusion as determined by laser-Doppler flowmetry.RESULTSThere was no difference between the groups regarding patient characteristics. Both groups remained haemodynamically stable throughout due to the use of approximately a 1.5 times higher total fluid volume in the Ringerfundin group than in the HES group: mean ± SD: 2581 ± 986 and 1803 ± 497) ml, respectively, (P = 0.011). There was no significant difference in the microcirculatory blood flow between the groups.CONCLUSIONOur results showed that when fluid management was guided by detailed haemodynamic assessment, more crystalloid than colloid was needed to maintain haemodynamic stability, but there was no difference between the effects of crystalloids and colloids on the microcirculation.TRIAL REGISTRATIONClinicalTrials.gov NCT03288051.

AB - BACKGROUNDMacro, and microcirculatory effects of crystalloids and colloids are difficult to compare, because interventions to achieve haemodynamic stability seldom follow similar criteria.OBJECTIVESOur aim was to compare the effects of crystalloids and colloids on the microcirculation during free flap surgery when management was guided by detailed haemodynamic assessment.DESIGNA randomised, controlled clinical trial.SETTINGSThe investigation was performed at the University of Szeged, Hungary.PATIENTSPatients undergoing maxillofacial tumour resection and free flap reconstruction were randomised into groups treated with either intra-operative crystalloid (Ringerfundin, n = 15) or colloid (6% hydroxyethyl starch, HES, n = 15) solutions.INTERVENTIONSMacrohaemodynamics were monitored by a noncalibrated device (PulsioFlex-PULSION). Central venous oxygen saturation, venous-to-arterial PCO2-gap, lactate levels and urine output were measured hourly. Maintenance fluid was Ringerfundin (1 ml kg-1 h-1), and a multimodal, individualised, approach-based algorithm was applied to guide haemodynamic support. Hypovolaemia was treated with Ringerfundin or HES fluid boluses, respectively. The microcirculatory effects were assessed by laser-Doppler flowmetry (PeriFlux 5000 LDPM), with the probe placed on the flap and on a control area. Measurements were performed after the flap was prepared, then 1 and 12 h later.MAIN OUTCOME MEASURESThe primary end-point was microcirculatory perfusion as determined by laser-Doppler flowmetry.RESULTSThere was no difference between the groups regarding patient characteristics. Both groups remained haemodynamically stable throughout due to the use of approximately a 1.5 times higher total fluid volume in the Ringerfundin group than in the HES group: mean ± SD: 2581 ± 986 and 1803 ± 497) ml, respectively, (P = 0.011). There was no significant difference in the microcirculatory blood flow between the groups.CONCLUSIONOur results showed that when fluid management was guided by detailed haemodynamic assessment, more crystalloid than colloid was needed to maintain haemodynamic stability, but there was no difference between the effects of crystalloids and colloids on the microcirculation.TRIAL REGISTRATIONClinicalTrials.gov NCT03288051.

UR - http://www.scopus.com/inward/record.url?scp=85069271823&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85069271823&partnerID=8YFLogxK

U2 - 10.1097/EJA.0000000000001024

DO - 10.1097/EJA.0000000000001024

M3 - Article

C2 - 31157652

AN - SCOPUS:85069271823

VL - 36

SP - 592

EP - 604

JO - European Journal of Anaesthesiology

JF - European Journal of Anaesthesiology

SN - 0265-0215

IS - 8

ER -