title: Resuscitation from septic shock with capillary leakage: hydroxyethyl starch (130 kd), but not Ringer's solution maintains plasma volume and systemic oxygenation.
abstract: There is evidence suggesting that early fluid resuscitation is beneficial in the treatment of septic shock. The question as to which solution should be used remains controversial. Using a porcine septic shock model, we tested the effects of a new synthetic colloid hydroxyethyl starch (HES 130 kD) and a crystalloid regimen with Ringer's solution (RS) on plasma volume (PV) maintenance as well as on systemic and regional hemodynamics. Fourteen anaesthetized mechanically ventilated pigs received 0.75 g kg body weight of feces into the abdominal cavity to induce sepsis. They were randomly allocated to receive 6% HES 130 kD (n = 5) or RS (n = 5) and were compared with nonseptic controls receiving 6% HES 130 kD (n = 4). The infusion rate was titrated to maintain a central venous pressure of 12 mmHg. PV was determined by chromium-51-tagged erythrocytes and hematocrit. Albumin escape rate (AER) was calculated using iodine-125-labeled albumin. Arterio-intramucosal pCO2 gap, systemic hemodynamics, and oxygenation were obtained before and 6 h after induction of sepsis. AER increased in the HES (+38%) and RS groups (+38%) compared with control. PV was reduced in the RS group (-39%), but was maintained in the HES group (-1%). After 6 h of sepsis, HES 130 kD-treated animals had a significantly higher cardiac output (166 +/- 28 mL min kg vs. 90 +/- 18 mL min kg, P < 0.05), and a significantly higher mixed-venous oxygen saturation (65% +/- 8% vs. 40% +/- 14%, P < 0.05) than RS animals. In this porcine septic shock model with concomitant capillary leakage syndrome, resuscitation with HES 130 kD but not RS could maintain PV and preserve systemic hemodynamics and oxygenation.
authors.affiliation: Department of Anaesthesia, University of Liverpool, Liverpool L69 3GA, United Kingdom. gmarx@liv.ac.uk
authors.forename: Gernot
authors.initials: G
authors.lastname: Marx
authors.forename: Samantha
authors.initials: S
authors.lastname: Pedder
authors.forename: Linda
authors.initials: L
authors.lastname: Smith
authors.forename: Seshapillai
authors.initials: S
authors.lastname: Swaraj
authors.forename: Steve
authors.initials: S
authors.lastname: Grime
authors.forename: Harold
authors.initials: H
authors.lastname: Stockdale
authors.forename: Martin
authors.initials: M
authors.lastname: Leuwer
mesh_terms: D000818:Animals; D002432:Cecum / Q000601:surgery; D004195:Disease Models, Animal; D005260:Female; D005440:Fluid Therapy; D006895:Hydroxyethyl Starch Derivatives / Q000494:pharmacology* / Q000627:therapeutic use*; D007552:Isotonic Solutions / Q000494:pharmacology*; D010100:Oxygen / Q000378:metabolism*; D010953:Plasma Volume / Q000187:drug effects* / Q000502:physiology; D012151:Resuscitation; D000077331:Ringer's Solution; D012772:Shock, Septic / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology*; D013552:Swine
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D000077331:Ringer's Solution; D010100:Oxygen