title: Effects of intravascular volume replacement on lung and kidney function and damage in nonseptic experimental lung injury.
abstract: BACKGROUND
  Intravascular volume replacement is often required in the presence of increased pulmonary capillary leakage, for example in patients with volutrauma with major hemorrhage. In the present study, the effects of Ringer's acetate (RA), gelatin-polysuccinate (GEL), and a modern hydroxyethyl starch (HES, 6% 130/0.42) on lung and kidney function and damage were compared in a two-hit model of acute lung injury. The authors hypothesized that GEL and HES, compared to RA: (1) reduced lung histological damage, (2) impaired kidney morphology and function.
  
  
  METHODS
  Acute lung injury was induced in 30 anesthetized pigs by tidal volumes approximately 40 ml/kg, after saline lung lavage. Protective ventilation was initiated and approximately≈25% of estimated blood volume was drawn. Animals were randomly assigned to receive RA, GEL, or HES (n = 10/group) aimed at approximately 90% of intrathoracic blood volume before blood drainage.
  
  
  RESULTS
  Fluid volumes were higher with RA (2,250 ± 764 ml) than GEL (704 ± 159 ml) and HES (837 ± 82 ml) (P < 0.05). Compared to RA, HES reduced diffuse alveolar damage overall, and GEL in nondependent zones only. GEL and HES yielded lower wet-to-dry ratios compared to RA (6.5 ± 0.5 and 6.5 ± 0.6 vs. 7.9 ± 0.9, respectively, P < 0.05). HES and RA resulted in less kidney damage than GEL, but kidney function did not differ significantly among groups. Compared to GEL, HES yielded lower lung elastance (55 ± 12 vs. 45 ± 13 cm H2O/l, P < 0.05) and intra-abdominal pressure (15 ± 5 vs. 11 ± 4 cm 14;H2O, P < 0.05).
  
  
  CONCLUSIONS
  In this model of acute lung injury, intravascular volume expansion after major hemorrhage with HES yielded less lung damage than RA and less kidney damage than GEL.
authors.affiliation: Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Therapy, University Hospital Dresden, Dresden, Germany.
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Silva
authors.forename: Andreas
authors.initials: A
authors.lastname: Güldner
authors.forename: Christopher
authors.initials: C
authors.lastname: Uhlig
authors.forename: Nadja
authors.initials: N
authors.lastname: Carvalho
authors.forename: Alessandro
authors.initials: A
authors.lastname: Beda
authors.forename: Ines
authors.initials: I
authors.lastname: Rentzsch
authors.forename: Michael
authors.initials: M
authors.lastname: Kasper
authors.forename: Bärbel
authors.initials: B
authors.lastname: Wiedemann
authors.forename: Peter M
authors.initials: PM
authors.lastname: Spieth
authors.forename: Thea
authors.initials: T
authors.lastname: Koch
authors.forename: Vera L
authors.initials: VL
authors.lastname: Capelozzi
authors.forename: Paolo
authors.initials: P
authors.lastname: Pelosi
authors.forename: Patricia R M
authors.initials: PR
authors.lastname: Rocco
authors.forename: Marcelo Gama
authors.initials: MG
authors.lastname: de Abreu
mesh_terms: D055371:Acute Lung Injury / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology*; D000758:Anesthesia; D000818:Animals; D001784:Blood Gas Analysis; D000077324:Crystalloid Solutions; D016207:Cytokines / Q000097:blood; D005260:Female; D005780:Gelatin / Q000627:therapeutic use; D006439:Hemodynamics / Q000187:drug effects; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use; D018836:Inflammation Mediators / Q000097:blood; D007552:Isotonic Solutions / Q000627:therapeutic use; D007668:Kidney / Q000473:pathology / Q000503:physiopathology*; D007677:Kidney Function Tests; D008168:Lung / Q000473:pathology / Q000503:physiopathology*; D010952:Plasma Substitutes / Q000627:therapeutic use*; D011650:Pulmonary Alveoli / Q000473:pathology; D012121:Respiration, Artificial; D012129:Respiratory Function Tests; D013552:Swine
chemical_list: D000077324:Crystalloid Solutions; D016207:Cytokines; D006895:Hydroxyethyl Starch Derivatives; D018836:Inflammation Mediators; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D005780:Gelatin