Randomized trial of hydroxyethyl starch versus gelatine for trauma resuscitation.
BACKGROUND
Previous studies have demonstrated the rapid increase in systemic capillary permeability after blunt trauma and its association with poor outcome. There are theoretical advantages in resuscitation with colloid fluids, which are well retained in the vascular compartment during times of capillary leak. The aim of this study was to compare the effects of posttrauma resuscitation with hydroxyethyl starch (HES) (molecular mass, 250 kDa) or gelatine (molecular mass, 30 kDa), the hypothesis being that HES would reduce capillary leak.


METHODS
Forty-five patients suffering blunt trauma were randomized on admission to receive either gelatine (Gelofusine) (n = 21) or HES (Pentaspan) (n = 24) for the first 24 hours, after which the choice of fluid was at the discretion of the clinician. The mean Injury Severity Score for the HES and gelatine groups were 20.0 (range, 9-41) and 18.1 (range, 9-32), respectively (p = 0.43). Capillary permeability was assessed by urine albumin excretion rate for the first 24 hours. For 5 days the daily mean P(O2)/F(IO2) ratio, serum C-reactive protein, hemoglobin, white cell and platelet counts, prothrombin, and activated partial thromboplastin time were recorded.


RESULTS
Capillary permeability was lower in HES-treated patients during the first 24 hours. Log mean (95% confidence interval) albumin excretion rate for gelatine and HES groups at 6 hours were 117.5 (84.9) and 46.8 (24.3) microg/min (p = 0.011), at 12 hours were 54.9 (30.0) and 17.2 (7.6) microg/min (p = 0.001), and at 24 hours were 50.5 (23.4) and 23.6 (16.3) microg/min (p = 0.030), respectively. The mean (95% confidence interval) P(O2)/F(IO2) ratio for the HES and gelatine groups 48 hours after admission were 324 (44) and 267 (43) mm Hg, respectively (p = 0.03). The mean (95% confidence interval) serum C-reactive protein in the HES and gelatine groups 24 hours after admission were 72.4 (19.2) and 105.7 (30.1) mg/L, respectively (p = 0.03). There were no significant differences in any of the hematologic parameters during the first 48 hours.


CONCLUSIONS
The results suggest that compared with gelatine, resuscitation with HES reduces posttrauma capillary leak.
Allison
K P
KP
West Midlands Regional Training Scheme, UK.
Gosling
P
P
Jones
S
S
Pallister
I
I
Porter
K M
KM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019559:Capillary Leak Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism / Q000517:prevention & control*; D002199:Capillary Permeability; D017809:Fatal Outcome; D005260:Female; D005780:Gelatin / Q000737:chemistry / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000737:chemistry / Q000494:pharmacology / Q000627:therapeutic use*; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D008970:Molecular Weight; D010952:Plasma Substitutes / Q000737:chemistry / Q000494:pharmacology / Q000627:therapeutic use*; D012151:Resuscitation / Q000379:methods*; D013386:Succinates / Q000737:chemistry / Q000494:pharmacology / Q000627:therapeutic use*; D013997:Time Factors; D014949:Wounds, Nonpenetrating / Q000150:complications*
D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D013386:Succinates; C060085:succinylated gelatin; D005780:Gelatin