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Peri-operative changes of haemodynamics and oxygen transport in patients undergoing haemodilution with bovine haemoglobin


Haemodynamic reactions following infusions of haemoglobin solutions have been shown in several animal experiments and may be of clinical concern. There is some evidence that vasoconstriction is a function of impurities of haemoglobin solutions. As a consequence, purification and chemical modification of haemoglobin should reduce adverse circulatory reactions. In animal models, ultrapurified polymerized bovine haemoglobin (HBOC-201) appears to be free of severe side effects. The present prospective study investigates haemodynamic changes and oxygen transport parameters in patients undergoing pre-operative haemodilution with HBOC-201 in comparison to hetastarch.


After institutional approval and written informed consent, 12 patients (6 m and 6 f, mean age 59 ± 10 years) underwent pre-operative haemodilution prior to elective liver resection. After induction of general anaesthesia, patients received an arterial line, a central venous and pulmonary catheter. Haemodynamic parameters and blood gases were measured before and after patients donated 1 l of their own blood and received 1 1 of Ringer's lactate (RL). Following haemodilution, patients were randomly allocated to receive either 0.4 g/kg HBOC-201 (Biopure, MA, group 1), or an equal volume of 6% hetastarch 70,000/0.5 (B Braun, FRG, group 2) plus 1 l of RL within 30 min. Haemodynamic and blood gas measurements were performed every 10 min during infusion of HBOC-201 or hetastarch, at the beginning of surgery and 4 h after arriving at the ICU. Values were tested using ANOVA and Mann-Whitney U-test with P < 0.05 considered as significant.


Demographic characteristics did not differ between groups. In contrast to group 2, the mean arterial blood pressure increased by 18% over baseline in group 1. While the pulmonary vascular resistance did not change in both groups, the systemic vascular resistance (SVR) increased to a maximum of 42% over baseline in group 1. Cardiac output (CO), mixed-venous oxygen content and oxygen delivery were lower in the HBOC-201 group. In contrast, arteriovenous oxygen difference and oxygen extraction ratio were higher in group 1 than in group 2, even on the ICU. Free haemoglobin reached a maximal concentration of 1.0 ± 0.2 g/dl 30 min after the HBOC-201 infusion was started.


In spite of ultrapurification of HBOC-201, the present haemodynamic data are consistent with different studies which show increased SVR and decreased CO following application of haemoglobin solutions. However, the long-lasting increase of oxygen extraction after HBOC-201 infusion which is provided by the low oxygen affinity of this compound may overcome potential adverse haemodynamic side effects.

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Standl, T., Wilhelm, S., Burmeister, M. et al. Peri-operative changes of haemodynamics and oxygen transport in patients undergoing haemodilution with bovine haemoglobin. Crit Care 1 (Suppl 1), P094 (1997).

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