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 c...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2020-08-01
|
| Series: | BMC Anesthesiology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12871-020-01104-9 |
| _version_ | 1818525517409681408 |
|---|---|
| author | Christian Reiterer Barbara Kabon Alexander Taschner Oliver Zotti Andrea Kurz Edith Fleischmann |
| author_facet | Christian Reiterer Barbara Kabon Alexander Taschner Oliver Zotti Andrea Kurz Edith Fleischmann |
| author_sort | Christian Reiterer |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-11T06:10:09Z |
| format | Article |
| id | doaj.art-f628f7d73d5b45598f02b676355b08e4 |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-12-11T06:10:09Z |
| publishDate | 2020-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-f628f7d73d5b45598f02b676355b08e42022-12-22T01:18:09ZengBMCBMC Anesthesiology1471-22532020-08-012011910.1186/s12871-020-01104-9A 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 surgeryChristian Reiterer0Barbara Kabon1Alexander Taschner2Oliver Zotti3Andrea Kurz4Edith Fleischmann5Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of ViennaDepartment of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of ViennaDepartment of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of ViennaDepartment of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of ViennaDepartment of Outcomes Research and General Anaesthesiology, Anaesthesiology InstituteDepartment of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of ViennaAbstract 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.http://link.springer.com/article/10.1186/s12871-020-01104-9Goal-directed fluid managementBrain natriuretic peptideTroponin TCrystalloidColloid |
| spellingShingle | Christian Reiterer Barbara Kabon Alexander Taschner Oliver Zotti Andrea Kurz Edith Fleischmann 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 BMC Anesthesiology Goal-directed fluid management Brain natriuretic peptide Troponin T Crystalloid Colloid |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | Goal-directed fluid management Brain natriuretic peptide Troponin T Crystalloid Colloid |
| url | http://link.springer.com/article/10.1186/s12871-020-01104-9 |
| work_keys_str_mv | AT christianreiterer acomparisonofintraoperativegoaldirectedintravenousadministrationofcrystalloidversuscolloidsolutionsonthepostoperativemaximumnterminalprobrainnatriureticpeptideinpatientsundergoingmoderatetohighrisknoncardiacsurgery AT barbarakabon acomparisonofintraoperativegoaldirectedintravenousadministrationofcrystalloidversuscolloidsolutionsonthepostoperativemaximumnterminalprobrainnatriureticpeptideinpatientsundergoingmoderatetohighrisknoncardiacsurgery AT alexandertaschner acomparisonofintraoperativegoaldirectedintravenousadministrationofcrystalloidversuscolloidsolutionsonthepostoperativemaximumnterminalprobrainnatriureticpeptideinpatientsundergoingmoderatetohighrisknoncardiacsurgery AT oliverzotti acomparisonofintraoperativegoaldirectedintravenousadministrationofcrystalloidversuscolloidsolutionsonthepostoperativemaximumnterminalprobrainnatriureticpeptideinpatientsundergoingmoderatetohighrisknoncardiacsurgery AT andreakurz acomparisonofintraoperativegoaldirectedintravenousadministrationofcrystalloidversuscolloidsolutionsonthepostoperativemaximumnterminalprobrainnatriureticpeptideinpatientsundergoingmoderatetohighrisknoncardiacsurgery AT edithfleischmann acomparisonofintraoperativegoaldirectedintravenousadministrationofcrystalloidversuscolloidsolutionsonthepostoperativemaximumnterminalprobrainnatriureticpeptideinpatientsundergoingmoderatetohighrisknoncardiacsurgery AT christianreiterer comparisonofintraoperativegoaldirectedintravenousadministrationofcrystalloidversuscolloidsolutionsonthepostoperativemaximumnterminalprobrainnatriureticpeptideinpatientsundergoingmoderatetohighrisknoncardiacsurgery AT barbarakabon comparisonofintraoperativegoaldirectedintravenousadministrationofcrystalloidversuscolloidsolutionsonthepostoperativemaximumnterminalprobrainnatriureticpeptideinpatientsundergoingmoderatetohighrisknoncardiacsurgery AT alexandertaschner comparisonofintraoperativegoaldirectedintravenousadministrationofcrystalloidversuscolloidsolutionsonthepostoperativemaximumnterminalprobrainnatriureticpeptideinpatientsundergoingmoderatetohighrisknoncardiacsurgery AT oliverzotti comparisonofintraoperativegoaldirectedintravenousadministrationofcrystalloidversuscolloidsolutionsonthepostoperativemaximumnterminalprobrainnatriureticpeptideinpatientsundergoingmoderatetohighrisknoncardiacsurgery AT andreakurz comparisonofintraoperativegoaldirectedintravenousadministrationofcrystalloidversuscolloidsolutionsonthepostoperativemaximumnterminalprobrainnatriureticpeptideinpatientsundergoingmoderatetohighrisknoncardiacsurgery AT edithfleischmann comparisonofintraoperativegoaldirectedintravenousadministrationofcrystalloidversuscolloidsolutionsonthepostoperativemaximumnterminalprobrainnatriureticpeptideinpatientsundergoingmoderatetohighrisknoncardiacsurgery |