title: In a porcine model of mixed acidemia HES 130/0.4 may support more stable hemodynamics during CVVH when compared to gelatine.
abstract: OBJECTIVE
  Continuous veno-venous hemofiltration (CVVH) and mixed acidemia often occur simultaneously in critically ill patients. In a previous study in non-acidemic pigs we found that colloids and CVVH interact specifically with respect to hemodynamic stability, with favorable effects for 6% HES 130/0.4 versus 4% gelatine (GEL) infusion. In a porcine model, we investigated whether these colloid-type associated differences are still dominant under acidemic conditions.
  
  
  METHODS
  We utilized 5 groups, a non-acidemic reference group receiving HES130 and CVVH; two acidemic groups receiving HES130 infusion (one with and one without CVVH); and two acidemic groups receiving GEL infusion (one with and one without CVVH). Mixed acidemia (pH ~7.20) was established by low tidal volume ventilation and acid infusion. Stable acidemia/CVVH application was maintained for 3 hours. Hemodynamics and blood gases were recorded.
  
  
  RESULTS
  Mixed acidemia led to a significant decrease in MAP and increase in MPAP in all groups. CVVH led to a further decrease in MAP but improved MPAP. During CVVH, HES130 ensured significantly higher MAP, Hb, and DO2 values than GEL infusion. In the groups without CVVH these differences between HES 130/0.4 and GEL were not observed.
  
  
  CONCLUSIONS
  As in a previous study in non-acidemic pigs, we found a colloid-specific influence of HES130 versus GEL on hemodynamics during CVVH under acidemia. Again, HES130 infusion may lead to favorable effects. In contrast, acidemia without CVVH application was dominant over the impact of a respective colloid. The application of a CVVH seems to be an important trigger for the overall circulatory response to a particular colloid.
authors.affiliation: Department of Experimental Medicine (FEM), Charité, Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany. Tobias_k@gmx.de
authors.forename: Tobias
authors.initials: T
authors.lastname: Keckel
authors.forename: Martin
authors.initials: M
authors.lastname: Russ
authors.forename: Janis R
authors.initials: JR
authors.lastname: Bedarf
authors.forename: Sascha
authors.initials: S
authors.lastname: Ott
authors.forename: Bernhard
authors.initials: B
authors.lastname: Hiebl
authors.forename: Nadine
authors.initials: N
authors.lastname: Haacke
authors.forename: Johanna J
authors.initials: JJ
authors.lastname: Wagner
authors.forename: Juliane K
authors.initials: JK
authors.lastname: Unger
mesh_terms: D000138:Acidosis / Q000188:drug therapy* / Q000503:physiopathology; D000818:Animals; D016638:Critical Illness; D004195:Disease Models, Animal; D006439:Hemodynamics / Q000187:drug effects* / Q000502:physiology; D006440:Hemofiltration / Q000379:methods*; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use*; D013552:Swine
chemical_list: C485123:HES 130-0.4; D006895:Hydroxyethyl Starch Derivatives