Assessment of hemodynamic and gastric mucosal acidosis with modified fluid versus 6% hydroxyethyl starch: a prospective, randomized study.
OBJECTIVE
To investigate the effect of 4 % succinylated modified fluid gelatin (MFG) versus mean weight, highly substituted 6% hydroxyethyl starch (HES) on hemodynamic and gastric mucosal acidosis variables, in septic hypovolemic patients.


METHODS
Prospective, randomized, clinical investigation.


METHODS
University hospital intensive care unit.


METHODS
Thirty-four septic hypovolemic ventilated and hemodynamically controlled patients.


METHODS
Invasive hemodynamic and gastric tonometric measurements.


RESULTS
Hemodynamic and tonometric parameters were recorded at baseline and 60 min after infusion of 500 ml of each colloid. In all patients central venous pressure, pulmonary artery occlusion pressure, cardiac index and mean arterial pressure increased significantly with both colloids, and hemoglobin concentration decreased by the same amount while oxygen delivery remained stable. Gastric intramucosal pH increased from 7.27 +/- 0.08 to 7.31 +/- 0.07 (p < 0.001) with MFG and decreased non-significantly from 7.26 +/- 0.11 to 7.22 +/- 0.08 (ns) with HES. Carbon dioxide gastric mucosal arterial gradient decreased from 18 +/- 9 to 13 +/- 9 mmHg (p < 0.0005) in the MFG group and rose non-significantly from 18 +/- 11 to 21 +/- 11 mmHg with HES.


CONCLUSIONS
Although MFG and 6% HES have the same hemodynamic effects, their physicochemical properties induce different responses on gastric mucosal acidosis in septic, hypovolemic and ventilated patients. These effects of MFG and HES on gastric mucosa need to be considered in patient management.
Asfar
P
P
Service de Réanimation Médicale, Centre Hospitalier Universitaire, Angers, France. Reamed@chu-angers.fr
Kerkeni
N
N
Labadie
F
F
Gouëllo
J P
JP
Brenet
O
O
Alquier
P
P
D000138:Acidosis / Q000209:etiology / Q000628:therapy*; D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D005745:Gastric Acidity Determination; D005753:Gastric Mucosa / Q000098:blood supply / Q000737:chemistry; D005780:Gelatin / Q000008:administration & dosage*; D006439:Hemodynamics; D006801:Humans; D006863:Hydrogen-Ion Concentration; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage*; D020896:Hypovolemia / Q000150:complications / Q000628:therapy; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000008:administration & dosage*; D011446:Prospective Studies; D018805:Sepsis / Q000150:complications / Q000628:therapy; D018709:Statistics, Nonparametric
D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D005780:Gelatin