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The risk associated with hyperoncotic colloids in patients with shock

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Abstract

Objective

Crystalloids, artificial and natural colloids have been opposed as representing different strategies for shock resuscitation, but it may be relevant to distinguish fluids based on their oncotic characteristics. This study assessed the risk of renal adverse events in patients with shock resuscitated using hypooncotic colloids, artificial hyperoncotic colloids, hyperoncotic albumin or crystalloids, according to physician’s choice.

Participants and setting

International prospective cohort study including 1,013 ICU patients needing fluid resuscitation for shock. Patients suffering from cirrhosis or receiving plasma were excluded.

Measurements and results

Influence of different types of colloids and crystalloids on the occurrence of renal events (twofold increase in creatinine or need for dialysis) and mortality was assessed using multivariate analyses and propensity score. Statistical adjustment was based on severity at the time of resuscitation, risks factor for renal failure, and on variables influencing physicians’ preferences regarding fluids. A renal event occurred in 17% of patients. After adjustment on potential confounding factors and on propensity score for the use of hyperoncotic colloids, the use of artificial hyperoncotic colloids [OR: 2.48 (1.24–4.97)] and hyperoncotic albumin [OR: 5.99 (2.75–13.08)] was significantly associated with occurrence of renal event. Overall ICU mortality was 27.1%. The use of hyperoncotic albumin was associated with an increased risk of ICU death [OR: 2.79 (1.42–5.47)].

Conclusions

This study suggests that harmful effects on renal function and outcome of hyperoncotic colloids may exist. Although an improper usage of these compounds and confounding factors cannot be ruled out, their use should be regarded with caution, especially because suitable alternatives exist.

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Acknowledgments

We thank the European Society of Intensive Care Medicine and the French Society of Intensive Care Medicine (Société de Réanimation de Langue Française) for providing the databases used to identify the study participants, Sophie Touati (Medical Intensive Care Unit, Henri Mondor Hospital, Créteil-France) for her secretarial assistance throughout the CRYCO study, and Gil Fraqueiro (Medical Intensive Care Unit, Henri Mondor Hospital Créteil-France) for his help in verifying the accuracy of data in the case-report forms. This study was supported by grant Projet Hospitalier de Recherche Clinique AOM00120 from the Assistance Publique-Hôpitaux de Paris (Paris Teaching Hospital Network, a nonprofit publicly funded organization).

Author information

Authors and Affiliations

  1. Réanimation Médicale, AP-HP, Groupe Hospitalier Albert Chenevier, Henri Mondor, 94000, Créteil, France

    Frédérique Schortgen, Nicolas Deye & Laurent Brochard

  2. Unité de Contrôle, Epidémiologie et Prévention de l’Infection, AP-HP, Groupe Hospitalier Albert Chenevier, Henri Mondor, 94000, Créteil, France

    Emmanuelle Girou

  3. Faculté de Médecine, Université Paris 12, 94000, Créteil, France

    Emmanuelle Girou & Laurent Brochard

  4. CeRBEP, Institut Pasteur, 75000, Paris, France

    Emmanuelle Girou

  5. INSERM, U841, 94000, Créteil, France

    Laurent Brochard

  6. Service de réanimation médicale, CHU Henri Mondor, 94000, Créteil, France

    Frédérique Schortgen

Authors
  1. Frédérique Schortgen
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  2. Emmanuelle Girou
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  3. Nicolas Deye
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  4. Laurent Brochard
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for the CRYCO Study Group

Corresponding author

Correspondence to Frédérique Schortgen.

Additional information

This article is discussed in the editorial available at: doi:10.1007/s00134-008-1226-1.

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Appendix

Appendix

Participants in the CRYCO cohort study

Australia: Parkville: The Royal Melbourn Hospital: J. Cade, M. Robertson, Intensive care unit; Sydney: Prince of Wales Hospital: Y. Shehabi, Intensive Care Unit. Austria: Graz: University hospital: K·H. Smolle, Department of intensive care; Innsbruck: University Hospital, B. Friesencker, A. Mayr, M. Dünser, Department of Anaesthesia and Intensive Care Medicine; Krems: KH Krems: T. Bauer, G. Kellner, Department of Anaesthesia and Intensive Care Medicine; Vienna: AKH Univzersity Hospital: M. Straganz, S. Hornykewycz, P. Mares, Cardiothoracic anaesthesia and Intensive Care Unit, Lainz Hospital: R. Fitzgerald, Department of Anaesthesia and Intensive Care Medicine, Wilhelminenspital: S. Fitzal, Department of Anaesthesia and Intensive Care Medicine. Belgium: Aalst: O.L.V. Hospital AALST: G. Nollet, Department of Anesthesiology and Intensive Care; Brussels: Hôpital Univ. St Luc: P. Hantson, Soins Intensifs; Genk: Ziekenhuis Oost-Limburg: R. de Jongh, R. Hens, M. Vandemierde, Intensive Care Unit 1; La Louvière: CHU Tivoli: S. Franck, Intensive Care Unit; Liège: CHU de Liège: M. Monchi, P. Damas, Soins intensifs généraux. Brazil: Niteroi: Hospital de Clinicas de Niteroi: P·C. Pereira De Souza, Intensive Care Unit; Porto Alegre: Hospital Sao Lucas Da PUCRS: F. Suparregui-Dias, General Intensive Care Unit; Sao Paulo: Hospital Do Servidor Publico Estadual-FMO: M. Assuncao, E. Rezende, Servicio de terapia intensiva adulto. Canada: Halifax: Queen Elizabeth II Health Sciences Center: L. Julien, R. Hall, Intensive Care Unit and Anaesthesiology; Toronto: Mount Sinai Hospital: T. Stewart, S. Katz, A. Rossi, Intensive Care Unit. Chile: Vina Del Mar: Hospital Dr Gustavo Fricke: S. Galvez, General Intensive Care Unit. Colombia: Cali: Fundacion Clinica Valle Del Lili: J.H. Mejia-Mantilla, Cuidados Intensivos Adultos. Croatia: Zagreb: Hospital for Infectious Diseases: M. Kutlesa, B. Barsic, Intensive care unit; University Hospital: V. Gasparovic, I. Gornic, Medical Intensive Care Unit. Czech republic: Brno: St Anne’ s University Hospital: L. Dadak, V. Sramek Department of Aanesthesiology and Intensive Care Unit; Prague: Institute for Clinical and Experimental Medicine: H. Riha, Department of Anaesthesiology and Intensive Care; University Hospital Kralovske Vinohrady: M. Balik, J. Pachl, B. Bakalar, P. Plasil, Department of Anaesthesiology and Intensive Care Unit. DENMARK: Aarhus: Aarhus University Hospital: P. Toft, H. Skriver, Anesthesiology and Intensive Care Unit; Copenhagen: Rigshospitalet: L.H. Quist Christensen, Department Of Intensive Care 4131. ESTONIA: Tallinn: Mustamae Hospital: V. Toome, K. Kakking, Department of Anaesthesia and IC; Tartu: University Hospital: M. Eerme, R. Suik, General Intensive Care. France: Angers: CHU d’Angers: A. Mercat, Réanimation Médicale et Médecine Hyperbare; Argenteuil: CH Victor Dupouy: G. Bleichner, H. Mentec, Réanimation Polyvalente; Auch: Centre Hospitalier: L. Mallet, Réanimation polyvalente; Béziers: Centre Hospitalier de Béziers: C. Gatecel, Réanimation Polyvalente; Boulogne: Ambroise Paré: K. Chergui, Réanimation médicale; Clamart: Hôpital Antoine Béclère: F. Jacobs, Réanimation médicale; Colmar: Hôpital Pasteur: J.P. Loeb, Anesthésie réanimation D; Créteil: Hôpital Henri Mondor: F. Lellouche, A. Alvarez, C. Brun-Buisson, Réanimation médicale; Dourdan: CH Dourdan: J.P. Colin, Unité de Soins Intensifs; Garches: CHU Raymond Poincaré: K. Chadda, D. Annane, Réanimation Médicale; Le Chesnay: Hôpital André Mignot. CH Versailles: F. Bruneel, Réanimation polyvalente; Le Kremlin Bicêtre: CHU de Bicêtre: C. Richard, X. Monnet, Réanimation Médicale; Lyon: Hôtel Dieu: E. Boselli, Rénimation Chirurgicale; Meaux: CH de Meaux: A. Combes, Réanimation Polyvalente; Metz: Bon Secours: T. Jacques, Réanimation Polyvalente; Orléans: CHR La Source: T. Boulain, I. Runge, Réanimation Polyvalente; Paris: Hôpital Bichat-Claude Bernard: M. Auburtin, J.F. Timsit, M. Wolff, B. Regnier, Réanimation médicale; H. Dupont, Réanimation chirurgicale; Hôpital Européen Georges Pompidou: E. Guérot, E. Iftimovici, Réanimation médicale; Cochin: A. Cariou, C. Goulenok, Réanimation médicale; Hôpital de la Pitié-Salpétrière: T. Similowski, A. Duguet, H. Prodanovic, Réanimation Pneumologique; Hôpital Saint-Louis : E. Azoulay, G. Thiery, Réanimation médicale; Hôpital Tenon: J.P. Fulgencio, G. Pelle, Réanimation Chirurgicale; Rennes: CHU de Pontchaillou: A. Person, Y. Le Tulzo, Réanimation Médicale et des Maladies Infectieuses; Rouen: Hôpital Charles Nicolle: J. Aboab, K. Clabault, G. Bonmarchand, C. Girault, Réanimation Médicale; Saint Etienne: Hôpital Bellevue: F. Zeni, Réanimation Polyvalente; Saint Germain en Laye: CHGI de Poissy- St- Germain en Laye: J.L. Ricome, Réanimation Polyvalente; Villejuif: Institut Gustave Roussy: F. Blot, C. Ede, Réanimation Médicale. Greece: Athens: Athens University School of nursing at “KAT” hospital: P. Evagelopoulou, G. Baltopoulos, Intensive Care Unit; Heraklion-Crête: University Hospital of Heraklion: E. Mouloudi, D. Georgopoulos, Department of Intensive Care Unit, Larissa: General Hospital: A. Komnos, A. Chovas, T. Paraforou, Intensive Care Unit; Thessaloniki : Papageorgiou General Hospital: A. Vakalos; Intensive Care Unit; Ahepa Univ Hospital: E. Sofianos, C. Skourtis, Anesthesiology and Intensive Care Unit. Germany: Amberg: Klinikum St Marien Amberg: S. Schmid, Internal Intensive Care Unit; Berlin: University Hospital Charite: C. Spies, Department of Anaesthesia and Intensive Care Medicine - Vivantes Klinikum Neukollen: X. Bartenschlager, Anesthesiology and Intensive Care; Darmstadt: Klinikum Darmstadt: M. Mueller, M. Welte, Institut fuer Anaesthesiology und operative Intensivmedizin; Dresden: University Hospital Carl Gustav Carus, Technische Universität: A. Osmers, M. Ragaller, Department of Anaesthesiology and Intensive Care; Gauting: Asklepios Fachkliniken: J. Geiseler, Intensive Care Unit; Rostock: University hospital: M. Puccini, D. Vagts, Clinic of anaesthesiology and intensive care medicine; Ulm: University Hospital: K. Traëger, Department of Anesthesiology; Wuerzburg: University of Wuerzburg: H·B. Reith, Department of Surgery. Hungary: Budapest: Semmelweis Med University: F. Janos, T. Gondos, Clinic of Transplantation and Surgery. Italy: Bari: University of Bari-Policlinico Hospital: G. Cinnella, Department of anesthesia and Intensive Care; Florence: Careggi Hospital: A. Peris, S. Batacchi, A. Piccioli, Anesth. Intensive Care 1; Milano : Ospedale San Paolo: M. Cigada, Anestesia e Rianimazione; Modena: Policlinico Di Modena: L. Donno, Massimo Girardis, Intensive Care Unit; Novara: Ospedalle Maggiore Della Carita, Universita del piemonte Oriental: F. Della Corte, R. Uboldi, General Intensive Care; Olbia: Ospedale Civile San Giovanni Di Dio: M. Messina, G. Piga, UO Anestesia e Rianimazione; Pavia: Policlinico San Matteo IRCCS: S. Pifferi, E. Haeusler, anestesia e rianimazione II; Roma: Policlinico Umberto 1, University “La Sapienza”: L. Tritapepe, F. Pompei, F. Macrino, Department of Cardiac Surgery; P. Pietropaoli, M. Rocco, A. Morelli, G. Spadetta, Anestesia-Rianimazione. Spain: Barcelona: Hospital S Creu I Sant Pau: O. Rubio, J. Mancebo, Servei Medicine Intensiva; Granada: Hospital “Virgen De Las Nieves”: J. Martin, Department of Critical and Emergency Medicine, L’Hospitalet de Lloretat: Hospital de a Creu Roja: A. Rovira, A. Lopez, L. Oussedik, J. Berrade, M. Cerda, Intensive Care Unit; Madrid: Hospital Universitario La Paz: A. Garcia De Lorenzo, Servicio de Medicina Intensiva; Hospital universitario de Getafe: J.A. Lorente, Cuidados intensivos; Reus: Hospital Universitari Sant Joan de Reus: I. Vallverdu, Department of intensive care; Sabadell: Corporacio Parc Tauli: F. Baigorri, L. Blanch Torra, R. Fernandez, Department of Intensive Care; Vitoria: Santiago Apostol Hospital - Osakidetza: A. Manzano, Intensive Care Unit. Mexico: Mexico City, Medica Sur Clinic Fundation: G. Castorena, Department of Intensive Care. Netherlands: Nijmegen: University Medical Center St. Radboud: S.J. Vaneuwen, Department of Intensive Care; Rotterdam: Erasmus University Medical center: B. Van Der Hoven, Surgical Intensive Care Unit. Norway: Stavanger: Sentralsjuhehuset: H·C. Nyrerod, Department of Anaesthesia. Peru: Lima: National Hospital Edgardo Rabagliati: S.E. Aliaga Viera, Critical Care Unit. Poland: Wroclaw: University of Medicine: P. Harbut, Department of Anaesthesiology and Intensive Therapy. Portugal: Viseu: Hospital de Sao Teotonio: A. Albuquerque, unidade de cuidados intensivos polivalente. Romania: Craiova: university of medicine and pharmacy: M.H. Vrabete, A. Garman, C. Petrica, H. Parvanescu, D. Georgescu, S. Danoiu, C. Taisescu, A. Nestianu, M. Firescu, S. Voinea, I. Georgescu, D. Margaritescu, V. Surlin, M. Mitricuna, Departement of anaesthesia and intensive care. Slovenia: Ljubljana : University Medical Center: V. Svigelj, Neuro Critical Care Unit. Sweden: Lund: University Hospital: S. Holbeck, Department of Anaesthesia and Intensive Care; Umea: Norrlands University Hospital: J. Claesson, S. Jakobsson, Department of Anaesthesia and Intensive Care. Switzerland: Chur: Kantonsspital Chur: A. Frutiger, Interdisciplinary Intensive Care Unit; Zürich: University Hospital Zürich: L. Silke, T. Gaspert, Department of Surgical Intensive Care; M. Fischler, Department of internal medicine and Intensive Care. Tunisie: Monastir: CHU Fatouma Bourguiba: Boussarsar M., Réanimation polyvalente; Montfleury: CAMU: N. Kouraichi, Reanimation, MIntensive Care Unit; Tunis: Rabta: A. Sami, Reanimation. Turkey: Denizli: Pamukkale University: H. Sungurtekin, Anesthesiology and Reanimation; Eskisehir: Osmangazi University Medical Faculty: B. Yelken, Department of Anaesthesiology and Intensive Care; Istanbul: Istanbul Medical Faculty: N. Cakar, S. 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Schortgen, F., Girou, E., Deye, N. et al. The risk associated with hyperoncotic colloids in patients with shock. Intensive Care Med 34, 2157–2168 (2008). https://doi.org/10.1007/s00134-008-1225-2

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