Comparison of the hemodynamic and oxygen transport responses to modified fluid gelatin and hetastarch in critically ill Patients

Beards, S. C.; Watt, Tracy; Edwards, J.; Nightingale, Peter; Farragher, E.

doi:10.1097/00003246-199404000-00015

Cited by 62 publications

(29 citation statements)

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“…For decades there has been a debate regarding whether one should use crystalloids or colloids [10][11][12][13], but there is also a debate regarding the efficacy of different colloids [14][15][16]. In contrast to colloids, crystalloids have small effects on coagulation, there is no risk of inducing allergic reactions, and they are inexpensive.…”

Section: Introductionmentioning

confidence: 99%

Plasma volume expansion of 5% albumin, 4% gelatin, 6% HES 130/0.4, and normal saline under increased microvascular permeability in the rat

2006

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Objective: To compare the colloids 5% albumin, 4% gelatine, and 6% HES 130/0.4 with one another, and with saline, regarding their plasma expanding effects at increased permeability, and to compare the results with those from a previous study at normal permeability.Design: Prospective controlled randomised laboratory study.Setting: University research laboratory.Subjects: 48 adult male Sprague-Dawly rats.Interventions: Permeability was increased by an injection of 0.5 ml dextran 70 using the fact that dextran causes anaphylactic reaction in the rat. Plasma volume was determined ( 125 I albumin tracer technique) after anaesthesia, 1 h after the dextran injection (before infusion for 10-15 min of 20 ml/kg bw of each of the colloids or 80 ml/kg of saline), and 3 h later. Blood pressure, haematocrit, blood gases and electrolytes were measured. CVP was measured in 4 rats. Measurements and results:Plasma volume was 41.1±1.9 ml/kg at baseline (n=9), and 29.1±4.1 ml/kg (n=35) 1 h after the dextran injection (p<0.05). Three hours after infusion of the plasma expander, plasma volume had increased by 17.1±3.4 ml/kg in the albumin group, by 7.9±3.6 ml/kg in the gelatine group, by 7.4±4.4 ml/kg in the HES group, and by 12.2±3.1 ml/kg in the saline group. It was unchanged in a control group given no solution (n=7 for all groups) (Means ± SD). Conclusion:Albumin was a more effective plasma volume expander than gelatine or HES or saline (p<0.05), which were equally effective. All solutions showed a smaller plasma expanding effect than observed in a previous study with normal permeability.3

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Section: Introductionmentioning

confidence: 99%

Plasma volume expansion of 5% albumin, 4% gelatin, 6% HES 130/0.4, and normal saline under increased microvascular permeability in the rat

2006

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“…It can be seen during volume replacement in emergency or intensive care medicine (1,15), is applied as standard practice during cardiopulmonary bypass (27), or is used in the form of normovolemic hemodilution as a clinical technique to reduce transfusion requirements in elective surgery (16,19). Hemodilution reduces the oxygen-carrying capacity of the blood with a decrease in hematocrit followed by a drop in peripheral resistance and an increase in venous return and cardiac output.…”

mentioning

confidence: 99%

Acute decrease in renal microvascular Po₂ during acute normovolemic hemodilution

Johannes

Mik²,

Nohé³

et al. 2007

American Journal of Physiology-Renal Physiology

121

122

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Johannes T, Mik EG, Nohé B, Unertl KE, Ince C. Acute decrease in renal microvascular PO 2 during acute normovolemic hemodilution. Am J Physiol Renal Physiol 292: F796 -F803, 2007. First published October 31, 2006 doi:10.1152/ajprenal.00206.2006.-Large differences in the tolerance of organ systems to conditions of decreased O2 delivery such as hemodilution exist. The kidney receives ϳ25% of the cardiac output and O2 delivery is in excess of the oxygen demand under normal circumstances. In a rat model of acute normovolemic hemodilution (ANH), we studied the effect of reduced hematocrit on renal regional and microvascular oxygenation. Experiments were performed in 12 anesthetized male Wistar rats. Six animals underwent four steps of ANH (hematocrit 25, 15, 10, and Ͻ10%). Six animals served as time-matched controls. Systemic and renal hemodynamic and oxygenation parameters were monitored. Renal cortical (c) and outer medullary (m) microvascular PO 2 (PO2) and the renal venous PO 2 (PrvO2) were continuously measured by oxygen-dependent quenching of phosphorescence. Despite a significant increase in renal blood flow in the first two steps of ANH, cPO 2 and mPO2 dropped immediately. From the first step onward oxygen consumption (V O2ren) became dependent on oxygen delivery (DO 2ren). With a progressive decrease in hematocrit, a significant correlation between PO 2 and V O2ren could be observed, as well as a PO2 gap between PO2 and P rvO2. Furthermore, there was a high correlation between V O2ren and RBF over a wide range of flows. In conclusion, the oxygen supply to the renal tissue is becoming critical already in an early stage of ANH due to the combination of increased V O2ren, decreased DO2ren, and intrarenal O 2 shunt. This has clinical relevance as recent publications reporting that hemodilution during surgery forms a risk factor for postoperative renal dysfunction.

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“…Želatinos tirpalai, pasiskirstydami tarp intravaskulinio ir ekstravaskulinio tarpo, didina cirkuliuojančio kraujo tūrį, todėl didėja vidurinis arterinis kraujo spaudimas, kairiojo skilvelio galinis diastolinis spaudimas, širdies indeksas, miokardo kontraktiliškumas, o tai sukelia kompensacinę hiperemiją (ypač reikš-minga nukraujavimo atveju), todėl gerėja deguonies pernaša į audinius, gali didėti diurezė (6,12,13). Kadangi želatinos tirpalai neturi buferinių savybių, todėl neveikia šarmų ir rūgščių pusiausvyros (14).…”

Section: Rūšisunclassified

Infusion solutions of gelatin derivates

Adukauskienė¹,

Mažeikienė²,

Veikutienė³

et al. 2009

Medicina

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ĮvadasCirkuliuojančio kraujo tūrio stygiaus korekcija reikšminga hipovolemijai gydyti bei profilaktikai. Hipovolemiją gali sukelti skysčių netekimas ar nukraujavimas, nudegimas, trauma, operacija, vazodilatacija dėl sepsio ar anestezijos indukcijos metu. Hipovolemijai ir šokui gydyti vartojami kristaloidiniai ir koloidiniai infuziniai tirpalai. Koloidų tirpalai yra natūralūs (plazma ir albuminas) ir dirbtiniai (dekstranai, želatinos tirpalai, hidroksietilkrakmolo dariniai). Jie didina plazmos koloidoonkotinį slėgį (KOS), kuris sulaiko vandenį kraujagyslėse, lengviau normalizuojasi cirkuliuojantis kraujo tūris. Nustatyta, jog koloidai gali gerinti deguonies pernašą į audinius, didinti miokardo kontraktiliškumą ir širdies indeksą bei išgyvenamumą. Kristaloidai beveik nepasižymi nepageidaujamu poveikiu, tačiau jie iš kraujagyslių lengvai patenka į intersticinį tarpą, todėl cirkuliuoti lieka tik 10-25 proc. sulašinto tirpalo kiekio (priklausomai nuo jo struktūros ir koncentracijos). Be to, kristaloidų infuzijos metu praskiedžiami plazmos baltymai, mažėja plazmos KOS, skatinamas tolesnis skysčių skverbimasis į audinius, dėl to tūris nepakankamas ir skatinama intersticinė edema (1-4).Koloidiniai tirpalai pradėti vartoti 20 a. I pasaulinio karo metu sužeistiesiems gydyti. Pirmasis koloidinis tirpalas buvo pagamintas iš akacijos medžio sakų, o jo vartojimas dažnai sietas su anafilaksinėmis ir kitomis nepageidaujamomis reakcijomis (3). Žela-tinos tirpalas, kaip koloidas, pirmą kartą pavartotas J. Hogan 1915 m. Tirpale vyravo didelės molekulinės masės molekulės, todėl kambario temperatūroje jis virsdavo želė ir tai ribojo jo vartojimą. Dabar sukurta daug koloidinių tirpalų, tinkamų hipovolemijai koreguoti, tačiau idealaus ir atitinkančio kraujo plazmos savybes koloidinio tirpalo dar nepavyko pagaminti. Tinkamas kraujo pakaitalas turėtų ne tik koreguoti ir užtikrinti adekvatų intravaskulinį tūrį, bet neturėti

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Comparison of the hemodynamic and oxygen transport responses to modified fluid gelatin and hetastarch in critically ill Patients

Cited by 62 publications

References 0 publications

Plasma volume expansion of 5% albumin, 4% gelatin, 6% HES 130/0.4, and normal saline under increased microvascular permeability in the rat

Plasma volume expansion of 5% albumin, 4% gelatin, 6% HES 130/0.4, and normal saline under increased microvascular permeability in the rat

Acute decrease in renal microvascular Po₂ during acute normovolemic hemodilution

Infusion solutions of gelatin derivates

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Comparison of the hemodynamic and oxygen transport responses to modified fluid gelatin and hetastarch in critically ill Patients

Cited by 62 publications

References 0 publications

Plasma volume expansion of 5% albumin, 4% gelatin, 6% HES 130/0.4, and normal saline under increased microvascular permeability in the rat

Plasma volume expansion of 5% albumin, 4% gelatin, 6% HES 130/0.4, and normal saline under increased microvascular permeability in the rat

Acute decrease in renal microvascular Po2 during acute normovolemic hemodilution

Infusion solutions of gelatin derivates

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Acute decrease in renal microvascular Po₂ during acute normovolemic hemodilution