title: Effects of crystalloids and colloids on liver and intestine microcirculation and function in cecal ligation and puncture induced septic rodents.
abstract: BACKGROUND
  Septic acute liver and intestinal failure is associated with a high mortality. We therefore investigated the influence of volume resuscitation with different crystalloid or colloid solutions on liver and intestine injury and microcirculation in septic rodents.
  
  
  METHODS
  Sepsis was induced by cecal ligation and puncture (CLP) in 77 male rats. Animals were treated with different crystalloids (NaCl 0.9% (NaCl), Ringer's acetate (RA)) or colloids (Gelafundin 4% (Gel), 6% HES 130/0.4 (HES)). After 24 h animals were re-anesthetized and intestinal (n = 6/group) and liver microcirculation (n = 6/group) were obtained using intravital microscopy, as well as macrohemodynamic parameters were measured. Blood assays and organs were harvested to determine organ function and injury.
  
  
  RESULTS
  HES improved liver microcirculation, cardiac index and DO(2)-I, but significantly increased IL-1β, IL-6 and TNF-α levels and resulted in a mortality rate of 33%. Gel infused animals revealed significant reduction of liver and intestine microcirculation with severe side effects on coagulation (significantly increased PTT and INR, decreased haemoglobin and platelet count). Furthermore Gel showed severe hypoglycemia, acidosis and significantly increased ALT and IL-6 with a lethality of 29%. RA exhibited no derangements in liver microcirculation when compared to sham and HES. RA showed no intestinal microcirculation disturbance compared to sham, but significantly improved the number of intestinal capillaries with flow compared to HES. All RA treated animals survided and showed no severe side effects on coagulation, liver, macrohemodynamic or metabolic state.
  
  
  CONCLUSIONS
  Gelatine 4% revealed devastated hepatic and intestinal microcirculation and severe side effects in CLP induced septic rats, whereas the balanced crystalloid solution showed stabilization of macro- and microhemodynamics with improved survival. HES improved liver microcirculation, but exhibited significantly increased pro-inflammatory cytokine levels. Crystalloid infusion revealed best results in mortality and microcirculation, when compared with colloid infusion.
authors.affiliation: Department of Anaesthesia and Critical Care, University of Würzburg, Würzburg, Germany.
authors.forename: Martin Alexander
authors.initials: MA
authors.lastname: Schick
authors.forename: Jobst Tobias
authors.initials: JT
authors.lastname: Isbary
authors.forename: Tanja
authors.initials: T
authors.lastname: Stueber
authors.forename: Juergen
authors.initials: J
authors.lastname: Brugger
authors.forename: Jan
authors.initials: J
authors.lastname: Stumpner
authors.forename: Nicolas
authors.initials: N
authors.lastname: Schlegel
authors.forename: Norbert
authors.initials: N
authors.lastname: Roewer
authors.forename: Otto
authors.initials: O
authors.lastname: Eichelbroenner
authors.forename: Christian
authors.initials: C
authors.lastname: Wunder
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D000818:Animals; D001778:Blood Coagulation Disorders / Q000139:chemically induced; D003102:Colloids / Q000494:pharmacology* / Q000627:therapeutic use; D000077324:Crystalloid Solutions; D005440:Fluid Therapy; D006439:Hemodynamics; D006895:Hydroxyethyl Starch Derivatives / Q000494:pharmacology* / Q000627:therapeutic use; D053583:Interleukin-1beta / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D019934:International Normalized Ratio; D007422:Intestines / Q000098:blood supply; D007552:Isotonic Solutions / Q000494:pharmacology* / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000098:blood supply*; D017093:Liver Failure / Q000097:blood / Q000150:complications / Q000503:physiopathology; D008297:Male; D008833:Microcirculation / Q000187:drug effects*; D010976:Platelet Count; D011517:Prothrombin Time; D051381:Rats; D017207:Rats, Sprague-Dawley; D018805:Sepsis / Q000097:blood / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: D003102:Colloids; D000077324:Crystalloid Solutions; C485123:HES 130-0.4; D006895:Hydroxyethyl Starch Derivatives; D053583:Interleukin-1beta; D015850:Interleukin-6; D007552:Isotonic Solutions; D014409:Tumor Necrosis Factor-alpha; D000410:Alanine Transaminase