title: Haemodynamic evaluation during small volume resuscitation in patients with acute respiratory failure.
abstract: In addition to the invasive haemodynamic monitoring procedures, an on-line assessment of cardiac performance by means of transoesophageal echocardiography might have a certain role in small volume resuscitation of patients with acute respiratory failure or Adult Respiratory Distress Syndrome (ARDS). The goal of this investigation was therefore to determine the effects of a hypertonic hyperoncotic solution, hypertonic hydoxyethl-starch (HHES), (HHES = HES [200.000/0.6-0.66; 60 g l-1; Leopold, Graz; Austria] combined with NaCl [75 g l-1) on haemodynamics and cardiac performance using the transoesophageal echocardiography. After institutional approval we investigated 23 patients suffering from septic ARDS after trauma or major surgery during four periods of resuscitation. Phase I = control values after infusion of 20 ml kg-1 crystalloid solution, phase II = 50% hypertonic hydroxyethyl-starch solution (2 ml kg-1), phase III = at the end of HHES (4 ml kg-1), IV = 30 min after the end of HHES. Before HHES-infusion, all patients showed arterial hypotension with mean arterial pressures of 64 +/- 2 mmHg. The infusion of 2 ml kg-1 HHES resulted in a significant increase of systemic and pulmonary arterial pressures over the study period. A significant improvement in cardiac output was associated with increasing stroke volumes, oxygen delivery and oxygen consumption (see Tables 1 and 2). Small volume resuscitation also resulted in significant increases of endsystolic and endiastolic left ventricular areas and the corresponding calculated wall stress (Figs 1-3). We conclude from our preliminary data that when using HHES, only modest fluid resuscitation was sufficient to restore adequate preload and oxygen delivery in patients with sepsis-related acute respiratory failure.
authors.affiliation: Department of Anaesthesia and General Intensive Care, University of Vienna, Austria.
authors.forename: H
authors.initials: H
authors.lastname: Steltzer
authors.forename: A N
authors.initials: AN
authors.lastname: Owen
authors.forename: P
authors.initials: P
authors.lastname: Krafft
authors.forename: C
authors.initials: C
authors.lastname: Weinstabl
authors.forename: A F
authors.initials: AF
authors.lastname: Hammerle
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D004305:Dose-Response Relationship, Drug; D017548:Echocardiography, Transesophageal; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage*; D006982:Hypertonic Solutions / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010101:Oxygen Consumption / Q000187:drug effects; D010952:Plasma Substitutes / Q000008:administration & dosage*; D012128:Respiratory Distress Syndrome / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D012151:Resuscitation / Q000295:instrumentation / Q000379:methods*; D018746:Systemic Inflammatory Response Syndrome / Q000150:complications; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000187:drug effects*
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D006982:Hypertonic Solutions; D010952:Plasma Substitutes