title: Influence of different volume replacement strategies on inflammation and endothelial activation in the elderly undergoing major abdominal surgery.
abstract: OBJECTIVE
  Adequate restoration of intravascular volume remains an important maneuver in the management of the surgical patient. Influence of different volume replacement regimens on inflammation/endothelial activation in elderly surgical patients was assessed.
  
  
  METHODS
  Prospective, randomized study.
  
  
  METHODS
  Surgical intensive care unit of a university-affiliated hospital.
  
  
  METHODS
  Sixty-six patients >65 years undergoing major abdominal surgery.
  
  
  METHODS
  Ringer's lactate (RL; n=22), normal saline solution (NS; n=22) or a low-molecular HES (mean molecular weight 130 kD) with a low degree of substitution (0.4; HES 130/0.4; n=22) were administered after induction of anesthesia until the 1st postoperative day (POD) to keep central venous pressure between 8-12 mmHg.
  
  
  RESULTS
  C-reactive protein, interleukins (IL-6, IL-8), adhesion molecules [endothelial leukocyte adhesion molecule-1 (ELAM-1) and intercellular adhesion molecule-1 (ICAM-1)] were measured prior to volume therapy at the end of surgery, 5 h after surgery and at the morning of the 1st POD. RL patients received 10,150+/-1,660 ml of RL, NS patients 10,220+/-1,770 ml of NS and the HES-treated group 2,850+/-300 ml of HES 130/0.4 and 2,810+/-350 ml of RL. Hemodynamics were similar in all groups. CRP, IL-6 and IL-8 plasma levels increased significantly higher in both crystalloid groups (IL-6 in the NS group: increase to 407+/-33 pg/ml; RL: increase to 377+/-35 pg/dl) than in the HES-130 treated group (IL-6: increase to 197+/-20 pg/dl). Plasma levels of ELAM-1 and ICAM remained almost unchanged in the HES 130-, but significantly increased in the RL- and NS-treated patients.
  
  
  CONCLUSIONS
  In elderly patients, markers of inflammation and endothelial injury and activation were significantly higher after crystalloid- than after HES 130/0.4-based volume replacement regimens.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Bremserstrasse 79, 67063 Ludwigshafen, Germany. boldtj@gmx.net
authors.forename: Joachim
authors.initials: J
authors.lastname: Boldt
authors.forename: Michael
authors.initials: M
authors.lastname: Ducke
authors.forename: Bernhard
authors.initials: B
authors.lastname: Kumle
authors.forename: Michael
authors.initials: M
authors.lastname: Papsdorf
authors.forename: Ernst-Ludwig
authors.initials: EL
authors.lastname: Zurmeyer
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000368:Aged; D000704:Analysis of Variance; D015815:Cell Adhesion Molecules / Q000097:blood; D000077324:Crystalloid Solutions; D004727:Endothelium / Q000378:metabolism / Q000503:physiopathology*; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use*; D007249:Inflammation / Q000378:metabolism / Q000503:physiopathology*; D007552:Isotonic Solutions; D008297:Male; D019990:Perioperative Care / Q000379:methods*; D010952:Plasma Substitutes / Q000627:therapeutic use*; D011446:Prospective Studies; D018709:Statistics, Nonparametric
chemical_list: D015815:Cell Adhesion Molecules; D000077324:Crystalloid Solutions; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes