Impact of high-molecular hydroxyethyl starch solutions on plasma volume and haemodynamics in porcine faecal peritonitis

Introduction

Early fluid resuscitation is suggested to be beneficial sepsis therapy. Using a faecal peritonitis model we tested effects of two new synthetic high-molecular hydroxyethyl starches, 6%HES 700/0.42/2.5:1 (HES700/2.5:1) and 6%HES 700/0.42/6:1 (HES700/6:1), compared with 6%HES 130/0.42 (HES130) and ringer's solution (RS) on plasma volume (PV), heart rate (HR), mean arterial pressure (MAP) and mixed venous oxygen saturation (SvO₂)^.

Methods

A prospective randomized, controlled animal laboratory study in a university animal laboratory. Twenty-five anaesthetized, ventilated pigs (28.4 ± 2.3 kg) received 1 g/kg/body weight faeces into the abdominal cavity to induce sepsis and were observed over 8 hours. Animals were randomized (five to each group) to volume replacement therapy with colloids or RS and were compared with a nonseptic control group receiving RS. The infusion rate was titrated to maintain a central venous pressure of 12 mmHg. PV was determined using chromium-51-tagged erythrocytes. Systemic haemodynamics and oxygenation were obtained before (Pre) and 8 hours after induction of sepsis. Statistics were performed with ANOVA.

Results

The PV (ml/kg/body weight) was significantly higher at study end with every kind of colloid (HES700/2.5:1: 68.5 ± 11.7; HES700/6:1: 65.5 ± 14.3, HES130: 64.4 ± 4.6) compared with RS (40.6 ± 5.9; P ≤ 0.05). The HR (1/min) rose in all peritonitis groups but not in the control group (NS). The MAP (mmHg) was significantly lower in the RS group (67 ± 11) compared with control (92 ± 4; P ≤ 0.05), but not in colloid-treated groups (HES700/2.5:1: 87 ± 15; HES700/6:1: 88 ± 12, HES130: 86 ± 11). SvO₂ (%) remained stable in all HES-treated animals and the control group over 8 hours, with significantly higher SvO₂ in all groups (HES700/2.5:1: 69 ± 3; HES700/6:1: 67 ± 16, HES130: 69 ± 8; control 70 ± 5) compared with RS at the study end (44 ± 17; P ≤ 0.05).

Conclusion

In this model, new high-molecular artificial colloids and HES130 could maintain the PV and preserve SvO₂ and haemodynamics significantly better than RS.