An optimistic view of OPTIMISE II?

Rupert Pearse’ OPTIMISE trial published in 2014 found that “use of a cardiac output–guided hemodynamic therapy algorithm compared with usual care did not reduce a composite outcome of complications and 30-day mortality.” My concern about the protocol was that it obliged research anaesthetists to give colloid solutions to all the therapy patients at a time when there were justified concerns about the safety profiles of the available solutions. Since OPTIMISE was planned & conducted we have had Yates’ remarkable trial  showing that omitting starch molecules from the “colloid” challenge fluid leads to less colloid-induced anaemia and more oxygen delivery. (1) Robert Hahn has almost single-handedly brought fluid kinetics to our attention in recent years and in a post-OPTIMISE review makes two very important points on perioperative fluid therapy. Firstly, “crystalloids will do the job in the operating room” and secondly “the therapeutic window for colloids is quite narrow”. (2) Many anaesthetists want to quit their colloid addiction, and many also want to monitor and so manipulate the intraoperative haemodynamics. When I saw OPTIMISE II announced I was therefore hoping for a starch-free goal directed group, but no! @rupert_pearse, if it is not too late, how about it?

  1. Yates DR, Davies SJ, Milner HE, Wilson RJ. Crystalloid or colloid for goal-directed fluid therapy in colorectal surgery. Br J Anaesth. 2014;112:281-289.
  2. Hahn RG. Why crystalloids will do the job in the operating room. Anaesthesiol Intensive Ther. 2014;46:342-349.

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