Hydroxyethyl starch and modified fluid gelatin maintain plasma volume in a porcine model of septic shock with capillary leakage.
OBJECTIVE
To compare the effects of different volume replacement therapies on maintenance of plasma volume in septic shock and capillary leakage syndrome.


METHODS
Prospective randomized, controlled animal laboratory study in a university animal laboratory.


RESULTS
Twenty-five fasted, anaesthetized, mechanically ventilated and multi-catheterized pigs (20.8+/-1.8 kg) received 1 g/kg body weight faeces into abdominal cavity to induce sepsis and were observed over 8 h. Five animals each received volume replacement therapy with modified fluid gelatin 4% or 8% (MFG4%, MFG8%), 6% HES 200/0.5, or Ringer's solution and were compared to controls receiving 6% HES 200/0.5. Infusion rate was titrated to maintain a central venous pressure of 12 mmHg. Plasma volume was determined using (51)Cr-labelled erythrocytes and standard formulae. Albumin escape rate was calculated using technetium (99m)Tc-labelled albumin. Colloid osmotic pressure, systemic haemodynamics and oxygenation were obtained before and 4 and 8 h after induction of sepsis. Plasma volume was reduced in the Ringer's solution group (-46%) but was maintained in HES (+/-0%), MFG4% (+4%), MFG8% (+23%) groups. Albumin escape rate increased in HES (+52%), MFG4% (+47%), MFG8% (+54%) and the Ringer's solution group (+41%) compared to controls.


CONCLUSIONS
In this porcine septic shock model with concomitant capillary leakage syndrome, confirmed by an increased albumin escape rate, the artificial colloids HES, MFG4%, and MFG8% maintained plasma volume and colloid osmotic pressure. These results suggest the intravascular persistency of artificial colloids in the presence of albumin leakage. An editorial regarding this article can be found in the same issue (http://dx.doi.org/10.1007/s00134-002-1283-9)
Marx
G
G
University Department of Anaesthesia, University of Liverpool, Liverpool L69 3GA, UK. gmarx@liv.ac.uk
Cobas Meyer
M
M
Schuerholz
T
T
Vangerow
B
B
Gratz
K F
KF
Hecker
H
H
Sümpelmann
R
R
Rueckoldt
H
H
Leuwer
M
M
D000418:Albumins / Q000378:metabolism; D000704:Analysis of Variance; D000818:Animals; D019559:Capillary Leak Syndrome / Q000150:complications*; D003102:Colloids / Q000008:administration & dosage; D004195:Disease Models, Animal; D005440:Fluid Therapy / Q000379:methods; D005780:Gelatin / Q000008:administration & dosage*; D006439:Hemodynamics / Q000187:drug effects; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage*; D009997:Osmotic Pressure; D010952:Plasma Substitutes / Q000008:administration & dosage*; D010953:Plasma Volume / Q000187:drug effects*; D011446:Prospective Studies; D012772:Shock, Septic / Q000150:complications*; D013552:Swine
D000418:Albumins; D003102:Colloids; D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D005780:Gelatin