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Microcirculatory response to fluid challenge: should we prefer balanced colloids to rebalance tissue perfusion?

Introduction

Fluid resuscitation should improve tissue oxygenation in hypovolemia, besides restoring macrohemodynamic stability [1]. We evaluated the microvascular response to fluid challenge with different colloid solutions and its relation to macrohemodynamics.

Methods

An observational study of patients receiving a fluid challenge (500 ml colloids in 30 minutes) according to the attending physician's decision. Before and after the infusion, sublingual microcirculation was evaluated with sidestream dark-field imaging (Microscan; Microvision Medical, Amsterdam, the Netherlands). Microvascular flow and density were assessed for small vessels [2]. The cardiac index (CI), intrathoracic blood volume index (ITBVI) and extravascular lung water index (ELWI) were measured in seven patients with PiCCO2 (Pulsion Medical System, Munich, Germany).

Results

Ten patients (two sepsis, four trauma, three intracranial bleeding, one post surgery) received either saline-based hydroxyethyl starch (HES) 130/0.4 (Amidolite®; B.BraunSpA; n = 5) or balanced HES 130/0.42 (Tetraspan®; B.BraunSpA; n = 5). The CI (P = 0.02) and ITBVI (P = 0.07) tended to increase, the EVLWI did not change. Microvascular flow and density improved in the whole sample. No correlation was found between macro-circulatory and micro-circulatory parameters. Balanced HES led to a greater increase in capillary density than NaCl HES (Figure 1).

Figure 1
figure1

Microvascular response to fluid challenge: effects of different colloids.

Conclusion

Balanced HES may be more efficacious than saline-based HES in recruiting the microcirculation, thereby improving tissue O2 delivery.

References

  1. 1.

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    De Backer , et al.: Crit Care. 2007, 11: R101. 10.1186/cc6118

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Correspondence to A Donati.

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Donati, A., Damiani, E., Domizi, R. et al. Microcirculatory response to fluid challenge: should we prefer balanced colloids to rebalance tissue perfusion?. Crit Care 17, P379 (2013). https://doi.org/10.1186/cc12317

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Keywords

  • Cardiac Index
  • Hydroxyethyl
  • Hydroxyethyl Starch
  • Fluid Challenge
  • Rebalance