A Comparison of Crystalloid Alone Versus Crystalloid Plus Colloid in Shock Resuscitation

Not Applicable

Interventions: Drug: Isotonic crystalloid solution resuscitation
Drug: Colloid solution resuscitation

Brief Summary: Fluid resuscitation is the most effective treatment of shock. Isotonic crystalloid solution is the current recommended initial fluid resuscitation. However, this kind of fluid has high volume of distribution and may require large volume administration before achieve therapeutic goal of shock reversal. There are rising concern about the delay in shock reversal and adverse consequences of large amount volume of fluid therapy. Colloid fluid have been used as the alternate fluid resuscitation, aiming to limit the volume of fluid resuscitation and promote shock reversal. Whether colloid infusion can improve shock reversal rate and decrease complication associated with fluid resuscitation, had inconclusive information.

Detailed Description: Fluid resuscitation is the most effective treatment of shock. Isotonic crystalloid solution is the current recommended initial fluid resuscitation. However, this kind of fluid has high volume of distribution and may require large volume administration before achieve therapeutic goal of shock reversal. There are rising concern about the delay in shock reversal and adverse consequences of large amount volume of fluid therapy. Colloid fluid have been used as the alternate fluid resuscitation, aiming to limit the volume of fluid resuscitation and promote shock reversal. Data from a recent randomized controlled study showed the improve long term survival among shock patients whose resuscitated with colloid solution. There were evidence about the increase incidence of acute kidney injury among critically ill patients who received hydroxyethyl starch, a previously worldwide used colloid solution. For septic shock, the leading cause of shock in current situation, resuscitation with albumin may associated with better outcome, while increasing mortality had been reported among the patient who received hydroxyethyl starch. Whether colloid infusion can improve shock reversal rate and decrease complication associated with fluid resuscitation, had inconclusive information.

Recruitment & Eligibility

Inclusion Criteria

Age at least 18 years old
New onset of shock within 24 hours
Mean arterial blood pressure less than 65 mmHg or systolic blood pressure less than 60% of patient's baseline blood pressure
Evidence of poor tissue perfusion including: urine output less than 0.5 mL/kg/hr, lactate more than 2 mmol/L, alteration of consciousness without other explanation
Evidence of fluid inadequacy (CVP < 12 mmHg, Pulmonary capillary wedge pressure < 18 mmHg) or evidence of fluid responsive (IVC diameter variation > 15%, pulse pressure variation > 15%, positive fluid challenge test)

Exclusion Criteria

Prolong shock more than 24 hours
Received colloid solution more than 1,000 mL in previous 72 hours
Do not resuscitation documented patient
Contraindication for fluid therapy including: suspected cardiogenic shock, evidence of pulmonary edema, history of anaphylaxis after fluid therapy

Arm && Interventions

Group	Intervention	Description
Crystalloid	Isotonic crystalloid solution resuscitation	Isotonic crystalloid solution resuscitation
Crystalloid plus Colloid	Isotonic crystalloid solution resuscitation	Colloid solution resuscitation
Crystalloid plus Colloid	Colloid solution resuscitation	Colloid solution resuscitation

Primary Outcome Measures

Name	Time	Method
Proportion of patients who had shock reversal	6 hours after initial resuscitation	Shock reversal was defined by mean arterial blood pressure \> 65 mmHg plus lactate clearance more than 10%

Secondary Outcome Measures

Name	Time	Method
Hospital mortality	90 days	Dead from any causes during hospital admission
Total fluid resuscitation within 24 hours	24 hours	Total volume of fluid resuscitation the patient received within 24 hours after enrollment
Mortality rate	28 days	Dead from any causes within 28 days after enrollment
Renal replacement therapy	28 days	Patient who required acute renal replacement therapy during admission

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