Impact of hetastarch on the intestinal microvascular barrier during ECLS.
The effects of hetastarch on microvascular fluid flux were determined in anesthetized dogs undergoing extracorporeal life support (ECLS) with a roller pump and membrane oxygenator. ECLS with a lactated Ringer priming solution resulted in a decrease in microvascular protein reflection coefficient and an increase in transvascular protein clearance. Use of a 6% hetastarch priming solution attenuated the decrease in microvascular protein reflection coefficient and blunted the increase in transvascular protein clearance. Ileal tissue water increased in the group treated with the lactated Ringer priming solution compared with the group treated with 6% hetastarch. The effective plasma-to-interstitial colloid osmotic pressure gradient was greater in the group treated with hetastarch than in the group treated with lactated Ringer solution. Hetastarch decreases the edema associated with ECLS. The reduction in edema is due to the maintenance of the plasma-to-interstitial colloid osmotic pressure gradient and the reduction in the microvascular permeability to protein.
Cox
C S
CS
Department of Surgery, Department of Anesthesiology, and Center for Microvascular and Lymphatic Studies, Medical School, University of Texas-Houston, Houston, Texas 77030, USA. ccox@utsurg.med.uth.tmc.edu
Brennan
M
M
Allen
S J
SJ
D000818:Animals; D001794:Blood Pressure; D002245:Carbon Dioxide / Q000097:blood; D002302:Cardiac Output; D004285:Dogs; D004487:Edema / Q000517:prevention & control; D005112:Extracorporeal Circulation / Q000009:adverse effects; D005766:Gastrointestinal Contents; D006439:Hemodynamics; D006895:Hydroxyethyl Starch Derivatives / Q000494:pharmacology*; D007422:Intestines / Q000098:blood supply*; D008021:Life Support Systems; D008208:Lymphatic System / Q000502:physiology*; D008833:Microcirculation / Q000187:drug effects / Q000502:physiology*; D009997:Osmotic Pressure; D010100:Oxygen / Q000097:blood; D010313:Partial Pressure; D010952:Plasma Substitutes / Q000494:pharmacology*
D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D002245:Carbon Dioxide; D010100:Oxygen