Randomized study comparing the effects of hydroxyethyl starch solution with Gelofusine on pulmonary function in patients undergoing abdominal aortic aneurysm surgery.
BACKGROUND
Restoring blood flow to ischaemic tissue can cause lung damage with pulmonary oedema. Hydroxyethyl starch (HES) solution, when used for volume replacement, may modify and reduce the degree of ischaemia-reperfusion injury. We compared the effects of HES solution with those of Gelofusine solution on pulmonary function, microvascular permeability and neutrophil activation in patients undergoing elective infrarenal abdominal aortic aneurysm surgery.


METHODS
Forty patients were randomized into two groups. The anaesthetic technique was standardized. Lung function was assessed with the PO(2)/FI(O(2)) ratio, respiratory compliance, chest x-ray and a score for lung injury. Microvascular permeability was determined by measuring microalbuminuria. Neutrophil activation was determined by measurement of plasma elastase.


RESULTS
Four hours after surgery, the median (quartile values) PO(2)/FI(O(2)) ratio was 40.3 (37.8, 53.1) kPa for the HES-treated patients compared with 33.9 (31.2, 40.9) kPa for the Gelofusine-treated patients (P<0.01, Mann-Whitney test). The respiratory compliance was 80 (73.5, 80) ml cm(-1) H(2)O in the HES-treated patients compared with 60.1 (50.8, 73.3) ml cm(-1) H(2)O in the Gelofusine-treated patients (P<0.01, Mann-Whitney test). The lung injury score 4 h after surgery was less for the patients treated with HES compared with the patients treated with Gelofusine (0.33 vs 0.71, P=0.01, Wilcoxon rank sum test). Mean (SD) plasma elastase was less in the HES-treated patients on the first postoperative day (1.96 (0.17) vs 2.08 (0.24), P<0.05). The log mean microalbuminuria was less in the HES-treated patients (0.41 vs 0.91 mg mmol(-1), P<0.05). This difference in microvascular permeability was associated with different volumes of colloid required to maintain stable cardiovascular measurements in the two groups of patients studied (3000 vs 3500 ml, P<0.01, Mann-Whitney test).


CONCLUSIONS
Compared with Gelofusine, the perioperative pulmonary function of patients treated with HES after abdominal aortic aneurysm surgery was better.
Rittoo
D
D
Department of Vascular Surgery, Selly Oak Hospital, University Hospital Birmingham NHS Trust, Raddlebarn Road, Selly Oak, Birmingham B29 6JD, UK.
Gosling
P
P
Burnley
S
S
Bonnici
C
C
Millns
P
P
Simms
M H
MH
Smith
S R G
SR
Vohra
R K
RK
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D002199:Capillary Permeability; D005260:Female; D005780:Gelatin / Q000627:therapeutic use*; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use*; D007430:Intraoperative Care / Q000379:methods; D008168:Lung / Q000503:physiopathology*; D008170:Lung Compliance / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D018375:Neutrophil Activation / Q000187:drug effects; D010100:Oxygen / Q000097:blood; D010196:Pancreatic Elastase / Q000097:blood; D010313:Partial Pressure; D010952:Plasma Substitutes / Q000627:therapeutic use*; D013386:Succinates / Q000627:therapeutic use*
D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D013386:Succinates; C060085:succinylated gelatin; D005780:Gelatin; D010196:Pancreatic Elastase; D010100:Oxygen