Effect of goal-directed crystalloid- versus colloid-based fluid strategy on tissue oxygen tension: a randomised controlled trial.

Abstract

Sufficient tissue oxygen tension may reduce the risk of postoperative wound infections. Supplemental administration of crystalloids increases subcutaneous oxygen tension (P_sqo₂). Colloids remain longer in the intravascular system and might therefore increase P_sqo₂ even more than crystalloids. Therefore, we tested the hypothesis that goal-directed colloid administration increases the perioperative P_sqo₂ more compared with crystalloid administration. We randomly assigned 80 patients undergoing elective open abdominal surgery to receive fluid boluses of hydroxyethyl starch (HES) or lactated Ringer's (LR) solution guided by oesophageal Doppler. Intraoperative P_sqo₂ was measured in the upper arm. After operation, we measured the P_sqo₂ in the upper arm and in the surgical wound. Forty patients were enrolled in each group. Patients in the colloid group received HES solution 750 ml (500; 1000) and LR solution 1500 ml (1000; 2000). Patients in the crystalloid group received LR solution 2825 ml (2000; 3960). The goal-directed administration of colloids did not improve intraoperative P_sqo₂ in the arm compared with crystalloid administration (11.4 kPa [9.0; 16.6] vs 11.2 kPa [8.6; 15.1], respectively; P=0.58). Postoperative arm P_sqo₂ was 8.1 kPa (6.5; 9.6) in the colloid group and 7.3 kPa (5.7; 9.1) in the crystalloid group (P=0.11). Postoperative surgical wound P_sqo₂ was 10.7 kPa (8.6; 13.4) in the colloid group and 10.1 kPa (8.1; 12.7) in the crystalloid group (P=0.68). Goal-directed colloid administration did not increase P_sqo₂ compared with goal-directed crystalloid administration in patients undergoing open abdominal surgery. NCT00517127.