title: Effects of hydroxyethyl starch and cell-free hemoglobin on microcirculation, tissue oxygenation, and survival in severe acute porcine pancreatitis: results of a randomized experimental trial.
abstract: OBJECTIVE
  Severe acute pancreatitis is a life-threatening disease with a high mortality; so far, no causal treatment is known. The aim of this study was to evaluate the therapeutic potential of hydroxyethyl starch (HES) and cell-free hemoglobin in an experimental model.
  
  
  METHODS
  Thirty-nine pigs were randomly assigned into 3 groups. Severe acute pancreatitis was induced by intraductal injection of glycodeoxycholic acid in combination with intravenous administration of cerulein. All animals were kept in isovolemic conditions by application of Ringer solution, 10% HES, or cell-free hemoglobin. The pancreatic microcirculation was evaluated over 8 hours. Thereafter, the animals were observed for 6 days followed by killing of the animals and histopathologic examination.
  
  
  RESULTS
  The administration of HES and cell-free hemoglobin led to improved microcirculation and tissue oxygenation compared with the Ringer's group. Consequently, the histopathologic damage was reduced (5.5 [3-8.5] vs 9.5 [7.5-11]; P < 0.001). In addition, the mean survival was significantly longer at 121 hours (95% confidence interval, 102-139) versus the Ringer group's 57 hours (95% confidence interval, 32-82; P < 0.001).
  
  
  CONCLUSIONS
  The administration of HES and cell-free hemoglobin can improve microcirculation in severe acute porcine pancreatitis, with consequent reduction in histopathologic damage and mortality. Therefore, this might represent an interesting therapeutic option in the treatment of severe acute pancreatitis.
authors.affiliation: From the *Department of General, Visceral, and Thoracic Surgery, University Medical Center Hamburg-Eppendorf; †Department of Anesthesiology and Intensive Care Medicine, Israelitic Hospital; and ‡Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Kai
authors.initials: K
authors.lastname: Bachmann
authors.forename: Marc
authors.initials: M
authors.lastname: Freitag
authors.forename: Hendrik
authors.initials: H
authors.lastname: Lohalm
authors.forename: Lena
authors.initials: L
authors.lastname: Tomkötter
authors.forename: Anna
authors.initials: A
authors.lastname: Dupree
authors.forename: Susan
authors.initials: S
authors.lastname: Koops
authors.forename: Tim
authors.initials: T
authors.lastname: Strate
authors.forename: Jakob R
authors.initials: JR
authors.lastname: Izbicki
authors.forename: Oliver
authors.initials: O
authors.lastname: Mann
mesh_terms: D000208:Acute Disease; D000818:Animals; D002108:Ceruletide; D006002:Glycodeoxycholic Acid; D006454:Hemoglobins / Q000008:administration & dosage / Q000494:pharmacology*; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage / Q000494:pharmacology*; D007552:Isotonic Solutions / Q000008:administration & dosage / Q000494:pharmacology; D008833:Microcirculation / Q000187:drug effects*; D010101:Oxygen Consumption / Q000187:drug effects*; D010179:Pancreas / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology; D010195:Pancreatitis / Q000139:chemically induced / Q000188:drug therapy* / Q000503:physiopathology; D011897:Random Allocation; D000077331:Ringer's Solution; D012720:Severity of Illness Index; D016019:Survival Analysis; D013552:Swine; D016896:Treatment Outcome
chemical_list: D006454:Hemoglobins; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D006002:Glycodeoxycholic Acid; D000077331:Ringer's Solution; D002108:Ceruletide