Goal-directed colloid administration improves the microcirculation of healthy and perianastomotic colon.
BACKGROUND
The aim of this study was to compare the effects of goal-directed colloid fluid therapy with goal-directed crystalloid and restricted crystalloid fluid therapy on healthy and perianastomotic colon tissue in a pig model of colon anastomosis surgery.


METHODS
Pigs (n = 27, 9 per group) were anesthetized and mechanically ventilated. A hand-sewn colon anastomosis was performed. The animals were subsequently randomized to one of the following treatments: R-RL group, 3 ml x kg(-1) x h(-1) Ringer lactate (RL); GD-RL group, 3 ml x kg(-1) x h(-1) RL + bolus 250 ml of RL; GD-C group, 3 ml x kg(-1) x h(-1) RL + bolus 250 ml of hydroxyethyl starch (HES 6%, 130/0.4). A fluid bolus was administered when mixed venous oxygen saturation dropped below 60%. Intestinal tissue oxygen tension and microcirculatory blood flow were measured continuously.


RESULTS
After 4 h of treatment, tissue oxygen tension in healthy colon increased to 150 +/- 31% in group GD-C versus 123 +/- 40% in group GD-RL versus 94 +/- 23% in group R-RL (percent of postoperative baseline values, mean +/- SD; P < 0.01). Similarly perianastomotic tissue oxygen tension increased to 245 +/- 93% in the GD-C group versus 147 +/- 58% in the GD-RL group and 116 +/- 22% in the R-RL group (P < 0.01). Microcirculatory flow was higher in group GD-C in healthy colon.


CONCLUSIONS
Goal-directed colloid fluid therapy significantly increased microcirculatory blood flow and tissue oxygen tension in healthy and injured colon compared to goal-directed or restricted crystalloid fluid therapy.
Kimberger
Oliver
O
Department of Anesthesiology and Pain Therapy, Inselspital-University Hospital Bern, Switzerland. study@kimberger.at
Arnberger
Michael
M
Brandt
Sebastian
S
Plock
Jan
J
Sigurdsson
Gisli H
GH
Kurz
Andrea
A
Hiltebrand
Luzius
L
D000714:Anastomosis, Surgical / Q000379:methods; D000818:Animals; D003102:Colloids / Q000008:administration & dosage*; D003106:Colon / Q000098:blood supply* / Q000187:drug effects / Q000601:surgery*; D005440:Fluid Therapy / Q000379:methods; D006040:Goals; D008833:Microcirculation / Q000187:drug effects* / Q000502:physiology; D013552:Swine
D003102:Colloids