The Effects of Isovolumetric and Isoeffective Infusions of Colloid Versus Crystalloid on Renal Blood Flood and Cardiac Output (BBraun)
1st February 2014 - ongoing
Team: Professor Dileep Lobo.
Restoration of blood volume in the perioperative period or in critically ill patients can be achieved with either crystalloid or colloid infusions. However, it is clear that for a given volume, the blood volume expanding properties of colloids are superior to crystalloids.Work done in healthy volunteers comparing the effects of 0.9% saline and 4% succinylated gelatin (Gelofusine) and 6% hydroxyethyl starch (Voluven) on blood volume showed that colloids, Gelofusine and Voluven resulted in an increase in blood volume of three times compared to the crystalloid, 0.9% saline. Colloids distribute predominantly in the vascular compartment and this property may have important consequences for visceral blood supply and thus function. Crystalloids tend to distribute mainly to the interstitium, giving rise to submucosal tissue oedema and may have adverse effects on wound healing when given in large volumes.
Most of the fluid retained after such infusions accumulates in the interstitial compartment, leading to oedema if overload exceeds 2-3 litres. In the face of acute illness, injury, surgery, and severe malnutrition, the capacity to excrete a salt and water load is further impaired, only returning to normal during convalescence.
Double blinded three way cross over study
In this study we aim to use a healthy human volunteer model to compare the effects of the following fluid regimes on blood volume, cardiac output as well as renal and coronary blood flow.
a) 1.5 L infusion over 1 hour of crystalloid [Sterofundin ISO (BBraun, UK)] - reference arm.
b) 0.5 L infusion over 1 hour of a balanced preparation of 4% gelatin [Gelaspan® (BBraun, UK)] -isoeffective arm.
c) 0.5 L infusion of 4% gelatin [Gelaspan® (BBraun, UK)] with 1.0 L infusion of crystalloid over 1 hour [Sterofundin ISO (BBraun, UK)] - isovolumetric arm
The primary end point of this study will be a difference in blood volume after infusion of the solutions in ml.
The secondary variables include changes in blood chemistry, haematology, urinalysis, cardiac output and aortic blood flow, and renal blood flow, perfusion and water content.
|Professor Dileep Lobo||Dileep Lobo is Professor of Gastrointestinal Surgery at the University of Nottingham and Consultant Hepatopancreaticobiliary Surgeon at Queens Medical Centre, Nottingham, UK. He qualified from Bangalore University, India and has trained as a surgeon in…|