Review Article

Intravenous Fluid of Choice in Major Abdominal Surgery: A Systematic Review

Table 3

Overview of randomized control trials in which the results were related to macrocirculation and intravascular volume effect categorized by primary outcome.

Author, yearFluid comparedNOperationConclusion

Primary outcome: hemodynamic parameters (dynamic parameter, static parameter, and colloid oncotic pressure)
Vogt [51], 19996% HES 200/0.5
5% human albumin
48Major urological surgeryNo significant difference in static hemodynamic parameters
HES has lower colloid oncotic pressure
Ragaller [41], 20006% HES 200/0.5 + 7.2%NaCl
6% HES 200/0.5 + 0.9%NaCl
29Abdominal aortic aneurysm repairHypertonic NaCl-HES needed lower volume and restored PCWP faster than HES in NSS after aortic clamp off
Ickx [24], 20036% HES130/0.4 (Voluven)
6% HES200/0.5
40Major abdominal surgeryNo significant difference in dynamic hemodynamic parameter
No significant difference in colloid oncotic pressure
Sander [48], 20036% HES130/0.4 (Voluven)
6% HES200/0.5
56Major gynecologicalNo significant difference in static hemodynamic parameter
No significant difference in volume needed to maintain hemodynamics
Feldheiser [15], 2013Jonosteril
6% HES130/0.4 (Volulyte)
48Cytoreductive surgeryHES reduced need for FFP and IV fluid to maintain hemodynamics. No significant difference in need for inotrope.
Szturz [50], 2014LRS
HES 130/0.4 (Voluven)
115Major urological surgeryHES reduced need for FFP and IV fluid to maintain hemodynamics

Primary outcome was another objective but also had these outcomes
Rittoo [47], 2005HES 200/0.62 (Elohes)
4% gelatin (Gelofusine)
40Abdominal aortic aneurysm repairLower HES intake to maintain hemodynamics compared to gelatin
Senagore [49], 2009Standard-LRS
GD-LRS
GD-hetastarch balance
64Laparoscopic colonic surgeryLower HES intake to achieved target stroke volume
Zhang [56], 2012Restricted-LRS
GD-LRS
GD-HES 130/0.4
Crystalloid : colloid ratio = 1.67 : 1
60GI surgeryHES reduced need of IV fluid to maintain hemodynamics
Hung [23], 2014LRS
6% HES 130/0.4 (Voluven)
80Major abdominal surgeryHES reduced need of IV fluid to maintain hemodynamics
Lavu [30], 2014LRS
3% NaCl
259Pancreaticoduodenectomy3% NaCl reduced need of IV fluid to static maintain hemodynamics
Yates [16], 2014Hartmann’s solution
6% HES 130/0.4 (Volulyte)
Crystalloid : colloid ratio = 1.6 : 1
202Colorectal surgeryHES reduced IV fluid to maintain hemodynamics
Kancir [27], 2015NSS
6% HES 130/0.4 (Voluven)
36Radical prostatectomyNo significant difference in fluid need to maintain hemodynamics
Deng [21], 2017LRS
4% gelatin (Gelofusine)
4.5% NaCl in 7.6% HES 40
36Laparoscopic colonic surgeryHS-HES can prolong effect of volume expansion and decreased systemic vascular resistance index
Joosten [17], 2018Plasmalyte
6% HES130/0.4 (Volulyte)
160Major abdominal surgeryHES reduced need of IV fluid to maintain hemodynamics by dynamic monitoring

HES = hydroxyethyl starch, NaCl = sodium chloride, PCWP = pulmonary capillary wedge pressure, NSS = normal saline solution, LRS = lactated Ringer’s solution, FFP = fresh frozen plasma, GD = goal-directed therapy, and GI = gastrointestinal.