Colloid with high fresh frozen plasma/red blood cell resuscitation does not reduce postoperative fluid needs

BACKGROUND Recent data suggest that intraoperative (Phase I) colloid (human serum albumin [HSA]) and a high fresh frozen plasma (FFP)/red blood cell (RBC) resuscitation will reduce postoperative (Phase II) fluid uptake. This study compares a noncolloid (balanced electrolyte solution [BES]) plus low (0.35) FFP/RBC resuscitation (Group A) with an HSA plus high (>0.35) FFP/RBC resuscitation. METHODS A previous randomized study of 94 patients included 48 BES patients and 46 HSA patients. A Subgroup A of 25 BES patients with low FFP/RBC was compared with a Subgroup D of 21 HSA patients with high FFP/RBC. Parameters monitored included Phase I vital signs and resuscitation needs; Phase II duration, BES needs, weight gain, and hourly urine output; and postoperative plasma volume (PV) by radioiodinated serum albumin (RISA), extracellular fluid (ECF) volume by inulin space, and interstitial volume by ECF-PV. RESULTS Admission pulse (132 for A vs. 133 for D), systolic blood pressure (SBP) (74 for A vs. 74 for D) and Phase I shock time (SBP < 80 Torr; 25 for A vs. 35 for D) were similar. Phase I RBC needs (12.5 1.3 for A vs. 14.9 1.7 for D) and BES needs (8.4 +/- 0.6 L for A vs. 8.4 +/- 0.6 L for D) were similar. During Phase II, D patients had more RBC, comparable BES, and weight gain, with lower hourly urine output compared with Group A patients. CONCLUSION HSA with high FFP/RBC does not prevent Phase II fluid uptake and causes lower urine output despite increased PV. Colloid reduces glomerular filtration, increases tubular reabsorption, and increases ECF, thus, prolonging Phase II. LEVEL OF EVIDENCE Therapeutic study, level IV.