Effects of hydroxyethyl starch resuscitation on extravascular lung water and pulmonary permeability in sepsis-related acute respiratory distress syndrome *

Huang, Chung-Chi; Kao, Kuo‐Chin; Hsu, Kuang-Hung; Ko, How-Wen; Li, Lifu; Hsieh, Meng‐Jer; Tsai, Ying‐Huang

doi:10.1097/ccm.0b013e3181a00268

Cited by 28 publications

(11 citation statements)

References 55 publications

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“…10,11 Furthermore, colloids may allow faster hemodynamic stabilization compared to crystalloids. 2,12 On the other hand, colloids have been implicated in kidney injury and dysfunction, 13 especially in the presence of sepsis. 14 However, the effects of crystalloids and colloids on lungs and kidneys in nonseptic ALI, for example ventilatorinduced lung injury or chest trauma associated with hemorrhage, are not well understood.…”

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confidence: 99%

Effects of Intravascular Volume Replacement on Lung and Kidney Function and Damage in Nonseptic Experimental Lung Injury

et al. 2013

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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 twohit 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. Effects of Intravascular Crystalloid versus Colloids in Nonseptic Lung InjuryResults: 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 H 2 O/l, P < 0.05) and intra-abdominal pressure (15 ± 5 vs. 11 ± 4 cm H 2 O, 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.

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confidence: 99%

Effects of Intravascular Volume Replacement on Lung and Kidney Function and Damage in Nonseptic Experimental Lung Injury

et al. 2013

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“…Nonetheless, it is well known that colloid infusion results in less extra-and intracellular edema as compared to crystalloids, even in the presence of vascular leakage (8,23,24). Intracellular edema of renal tubular cells may in turn increase shear stress of the apical mucosa, resulting in destruction of the microvilli brush border as seen in the present study.…”

Section: Discussionmentioning

confidence: 59%

Effects of balanced crystalloid vs. 0.9% saline-based vs. balanced 6% tetrastarch infusion on renal function and tubular integrity in ovine endotoxemic shock*

Ertmer

Kampmeier

Rehberg

et al. 2011

Critical Care Medicine

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“…In contrast to patients with hydrostatic pulmonary edema, more patients with ALI and ARDS had decreased alveolar fluid clearance, which correlated with worse clinical outcome [25]. However, EVLWI did not increase in patients with sepsis-related ARDS after fast administration of 500 mL HES solution [26].…”

Section: To Recruitment As Shown By Good Oxygenation and A Low Intramentioning

confidence: 97%

Pulmonary effects of positive end-expiratory pressure and fluid therapy in experimental lung injury

Kredel

Muellenbach

Schlegel

et al. 2010

Experimental Lung Research

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The separate effects of positive end-expiratory pressure (PEEP) and intravascular volume administration on the histopathologic lung injury were not investigated in experimental lung injury previously. The authors hypothesized that high PEEP and a restrictive volume therapy would yield the best oxygenation and the least degree of lung injury. Pigs (52.8 ± 3.4 kg) underwent saline lavage-induced lung injury. The animals were ventilated either with low PEEP (mean PEEP 9 to 12 cm H₂O) and liberal volume therapy using hydroxyethyl starch (LowP/Vol+) or high PEEP (mean PEEP 21 cm H₂O) combined with recruitment maneuvers and liberal (HighP/Vol+) or restrictive volume therapy (HighP/Vol-). After 6.5 hours, lung injury was determined by using a histopathologic score evaluating overdistension, edema, exsudation, and inflammation. When volume therapy was liberal, high PEEP (HighP/Vol+) improved the Pao₂/Fio₂ index (416 ± 80 mm Hg) compared to low PEEP (LowP/Vol+, 189 ± 55 mm Hg; P < .05) but there was no difference in the median (interquartile range) lung injury score: 1.6 (1.2-1.9) and 1.9 (1.4-2.0). High PEEP with restrictive volume therapy (HighP/Vol-) did not further improve oxygenation (400 ± 55 mm Hg) but ameliorated the degree of lung injury: 0.9 (0.8-1.4) (P < .05). In lavage-induced lung injury, high PEEP improved oxygenation, but restrictive volume administration markedly reduced the lung injury score, mainly by reduced edema.

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Effects of hydroxyethyl starch resuscitation on extravascular lung water and pulmonary permeability in sepsis-related acute respiratory distress syndrome *

Abstract: In patients with early ARDS, pentastarch resuscitation significantly improved their hemodynamics and cardiac output without worsening pulmonary edema and pulmonary mechanics. It even attenuated pulmonary vascular permeability.

Cited by 28 publications

References 55 publications

Effects of Intravascular Volume Replacement on Lung and Kidney Function and Damage in Nonseptic Experimental Lung Injury

Effects of Intravascular Volume Replacement on Lung and Kidney Function and Damage in Nonseptic Experimental Lung Injury

Effects of balanced crystalloid vs. 0.9% saline-based vs. balanced 6% tetrastarch infusion on renal function and tubular integrity in ovine endotoxemic shock*

Pulmonary effects of positive end-expiratory pressure and fluid therapy in experimental lung injury

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