Volume therapy with colloid solutions preserves intestinal microvascular perfusion in endotoxaemia.
Colloid solutions have been suggested to improve microvascular perfusion due to their anti-inflammatory properties. Whether this also applies for the gut, an important immunological organ vulnerable to hypoperfusion is unknown. This study investigated intestinal microcirculation of endotoxaemic rats after volume therapy with colloid solutions such as hydroxyethyl starch (HES) and gelatin or isotonic saline (NaCl). In addition intestinal oxygenation and morphology as well as mesenteric leukocyte-endothelium interaction were quantified. Rats were anaesthetised with urethane and ketamine, mechanically ventilated, and monitored haemodynamically. Normotensive endotoxaemia was induced by a continuous intravenous infusion of Escherichia coli lipopolysaccharide (LPS, 1.5 mg kg(-1) h(-1)). After 1 h of LPS infusion either 6% HES (16 ml kg(-1)), 4% gelatin (16 ml kg(-1)) or 0.9% NaCl (64 ml kg(-1)) were infused for 1 h. Using intravital microscopy, functional capillary density (FCD) and red blood cell velocity (RBCV) were measured in the mucosa of the terminal ileum at baseline and 3 h after volume therapy. In another set of animals, mesenteric leukocyte-endothelium interaction was determined 3 h after volume therapy. In all animals intestinal lactate/pyruvate ratio and intestinal morphology were assessed. Three hours after volume therapy, FCD decreased in NaCl (808 [749/843] cm(-1); median [quartiles] P<0.05 versus baseline) but not in HES (995 [945/1036] cm(-1)) and gelatin (988 [867/1193] cm(-1)) groups. RBCV, lactate/pyruvate ratio and intestinal morphology did not differ among groups. Also mesenteric leukocyte-endothelium interaction was not significantly influenced by either treatment. In conclusion, early volume therapy with HES or gelatin, but not with NaCl, preserved gut microvascular perfusion during endotoxaemia but did not have a significant effect on tissue oxygenation nor morphological appearance in this experimental model. An anti-inflammatory effect of colloid solutions was not seen and fails to explain the changes in intestinal microcirculation.
Schäper
Jörn
J
Department of Anesthesiology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany. joern.schaeper@charite.de
Ahmed
Raees
R
Schäfer
Tobias
T
Elster
Antje
A
Enigk
Fabian
F
Habazettl
Helmut
H
Mousa
Shaaban
S
Schäfer
Michael
M
Welte
Martin
M
D000818:Animals; D000077324:Crystalloid Solutions; D019446:Endotoxemia / Q000628:therapy*; D005780:Gelatin / Q000494:pharmacology*; D006895:Hydroxyethyl Starch Derivatives / Q000494:pharmacology*; D007422:Intestines / Q000098:blood supply*; D007552:Isotonic Solutions / Q000494:pharmacology*; D008070:Lipopolysaccharides; D008297:Male; D008833:Microcirculation / Q000187:drug effects*; D051381:Rats; D017207:Rats, Sprague-Dawley; D012151:Resuscitation / Q000379:methods*; D012965:Sodium Chloride / Q000494:pharmacology*; D018709:Statistics, Nonparametric
D000077324:Crystalloid Solutions; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D008070:Lipopolysaccharides; D012965:Sodium Chloride; D005780:Gelatin