Fluid resuscitation with colloids of different molecular weight in septic shock.
OBJECTIVE
The aim of this study was to investigate the short-term effect of fluid resuscitation with 4% modified fluid gelatine (GEL) versus 6% hydroxyethyl starch (HES) on haemodynamics and oxygenation in patients with septic shock and acute lung injury (ALI).


METHODS
Prospective randomised clinical trial.


METHODS
Twenty-bed intensive care unit in a university hospital.


METHODS
Thirty hypovolemic patients (intrathoracic blood volume index, ITBVI <850 ml/m(2)) in septic shock with ALI were randomised into HES (mean molecular weight: 200,000 Dalton, degree of substitution 0.6) and GEL (mean molecular weight: 30,000 Dalton) groups (15 patients each).


METHODS
For fluid resuscitation 250 ml/15 min boluses (max. 1,000 ml) were given until the end point of ITBVI >900 ml/m(2) was reached. Repeated haemodynamic measurements were done at baseline (t(b)), at the end point (t(ep)) then at 30 min and 60 min after the end point was reached (t(30), t(60)). Cardiac output, stroke volume, extravascular lung water (EVLW), and oxygen delivery was determined at each assessment point. For statistical analysis two-way ANOVA was used.


RESULTS
ITBVI, cardiac index, and oxygen delivery index increased significantly at t(ep) and remained elevated for t(30) and t(60), but there was no significant difference between the two groups. The increase in the ITBVI by 100 ml of infusion was similar in both groups (HES: 26+/-19 ml/m(2) vs GEL: 30+/-19 ml/m(2)). EVLW, remained unchanged, and there was no significant difference between the groups (HES, t(b): 8+/-6, t(60): 8+/-6; GEL, t(b): 8+/-3, t(60): 8+/-3 ml/kg). The PaO(2)/FiO(2) did not change significantly over time or between groups (HES, t(b): 207+/-114, t(60): 189+/-78; GEL, t(b): 182+/-85, t(60): 182+/-85 mmHg).


CONCLUSIONS
The results of this study indicate that both HES and GEL infusions caused similar short-term change in ITBVI in septic shock, without increasing EVLW or worsening oxygenation.
Molnár
Zsolt
Z
Department of Anaesthesiology and Intensive Care, University of Pécs, Pécs, Hungary. z_molnar@hotmail.com
Mikor
András
A
Leiner
Tamás
T
Szakmány
Tamás
T
D000328:Adult; D003102:Colloids / Q000737:chemistry / Q000627:therapeutic use; D015633:Extravascular Lung Water / Q000187:drug effects / Q000378:metabolism; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D005780:Gelatin / Q000627:therapeutic use; D005782:Gels / Q000627:therapeutic use; D006439:Hemodynamics; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D008970:Molecular Weight; D010102:Oxygen Inhalation Therapy; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000628:therapy; D012151:Resuscitation / Q000379:methods*; D012772:Shock, Septic / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome
D003102:Colloids; D005782:Gels; D006895:Hydroxyethyl Starch Derivatives; D005780:Gelatin