Comparison of the effects of lactated Ringer solution with and without hydroxyethyl starch fluid resuscitation on gut edema during severe splanchnic ischemia

Abstract

The type of fluid used during resuscitation may have an important impact on tissue edema. We evaluated the impact of two different regimens of fluid resuscitation on hemodynamics and on lung and intestinal edema during splanchnic hypoperfusion in rabbits. The study included 16 female New Zealand rabbits (2.9 to 3.3 kg body weight, aged 8 to 12 months) with splanchnic ischemia induced by ligation of the superior mesenteric artery. The animals were randomized into two experimental groups: group I (N = 9) received 12 mL·kg -1 ·h -1 lactated Ringer solution and 20 mL/kg 6% hydroxyethyl starch solution; group II (N = 7) received 36 mL·kg -1 ·h -1 lactated Ringer solution and 20 mL/kg 0.9% saline. A segment from the ileum was isolated to be perfused. A tonometric catheter was placed in a second gut segment. Superior mesenteric artery (Q SMA ) and aortic (Q aorta ) flows were measured using ultrasonic flow probes. After 4 h of fluid resuscitation, tissue specimens were immediately removed for estimations of gut and lung edema. There were no differences in global and regional perfusion variables, lung wet-to-dry weight ratios and oxygenation indices between groups. Gut wet-to-dry weight ratio was significantly lower in the crystalloid/colloidtreated group (4.9 ± 1.5) than in the crystalloid-treated group (7.3 ± 2.4) (P < 0.05). In this model of intestinal ischemia, fluid resuscitation with crystalloids caused more gut edema than a combination of crystalloids and colloids.

Hydroxyethyl Starch (HES 130/0.4) Impairs Intestinal Barrier Integrity and Metabolic Function: Findings from a Mouse Model of the Isolated Perfused Small Intestine

“…This important function is for example impaired during inflammatory processes and microbial sepsis, which induce an increased endothelial and epithelial permeability leading to intestinal edema formation and passage of bacterial toxins as well as pathogens into the systemic circulation [ 6 – 10 ]. In spite of the central role of the intestine in metabolism, inflammation and sepsis, information about the effects of HES solutions on intestinal function and barrier integrity is still very scarce [ 8 , 11 , 12 ].…”

Restrictive strategy of intraoperative fluid maintenance during optimization of oxygen delivery decreases major complications after high-risk surgery

“…In experimental models, colloid increases microcirculatory blood flow and tissue oxygen tension in the gut mucosa [38]. In a model of gut ischemia in rabbits, crystalloid administration was associated with more gut edema than a combination of colloid with less crystalloid [39]. Patients in the restrictive group received more fluid challenges (3.1 per patient) than did patients in the conventional group (2.4 per patient).…”

Current aspects of perioperative fluid handling in vascular surgery

“…Experimental data suggested, as early as in 1983, that the reason for interstitial oedema might be a combination of both the surgical trauma and the traditional anaesthesiological fluid management [29]. Recent experiments confirmed that replacing a pure crystalloidal strategy by a combined one, including colloids, significantly reduces gut oedema in rabbits [30 ].…”