Abstract
BackgroundN-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.MethodsThirty 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.ResultsIn 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).ConclusionsBased on this relatively small study goal-directed colloid administration did not decrease postoperative maxNT-proBNP concentration as compared to goal-directed crystalloid administration.Trial registrationClinicalTrials.gov (NCT01195883) Registered on 6th September 2010.
Highlights
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
In one patient in the crystalloid group surgery was cancelled after randomisation; 29 patients received the allocated intervention
In the colloid group 3 patients were lost to follow up; data from 27 patients were analysed (Fig. 1). Patient characteristics such as age, Body Mass Index (BMI), gender, American Society of Anaesthesiologists (ASA) classification, Revised Cardiac Risk Index (RCRI), comorbidities, long-term medication, type of surgery and preoperative laboratory values were comparable in both groups (Table 1)
Summary
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. The relative effects of goal-directed, intravenous administration of crystalloid compared to colloid solutions on NTproBNP and troponin T, especially in relatively healthy patients undergoing moderate- to high-risk noncardiac surgery, remains unclear. We evaluated in this sub-study the effect of a goal-directed crystalloid versus a goaldirected colloid fluid regimen on postoperative maximum NT-proBNP concentration. Goal-directed perioperative fluid strategies are used to improve haemodynamic stability and optimize cardiac performance [2] with the aim to reduce postoperative morbidity and mortality [3,4,5]. Goal-directed colloid administration reduces the amount of fluid for maintaining haemodynamic stability during surgery [9]. Intraoperative haemodynamic stability, especially the maintenance of a mean arterial blood pressure greater than 65 mmHg may be associated with a reduced risk of myocardial injury [10]
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