Please see Bibliography of References for a list of abstracts, manuscripts and posters.
Marx G, Simon TP, Schuerholz T, Petzel P, Haugvik SP, Forberger C, Reinhart K. Int Care Med. 2006;32(Supp 1):S76. Abstract 0282.
Introduction: Microcirculatory alterations result into inadequate tissue oxygenation and multi organ dysfunction during severe sepsis and septic shock. It seems to be important to guarantee adequate volume repracement in sepsis in order to improve the microcircuratory flow. Using an established faecal peritonitis model we tested the effects of two new synthetic high molecular hydroxyethyl starches HES 700/0.42/2.5:1 (HES700/2.5:1) and HES 700/0.42/6:1 compared to HES 130/0.42 (HES130) and ringer’s solution (RS) on tissue oxygenation (StO2), microvascular reactivity and gastrointestinal CO2 gap.
Methods: Prospective randomised, controlled animal study. 25 anaesthetised, ventilated pigs (28.4±2.3 kg) were randomized (5 each group) to volume replacement therapy with colloids, RS or a non-septic control group receiving RS. Animals in the septic groups received 1g/kg/body weight faeces into abdominal cavity to induce sepsis. Infusion rate was titrated to maintain a central venous pressure of 12 mmHg. Quadriceps muscle StO2 was measured by NIRS using the artery occlusion method. Microvascular reactivity alterations was evaluated by the calculation of the slope of the decrease in StO2 (decslope [%/sec]) during and the calculation of the slope of the increase in StO2 (incslope [%/sec]) during and after the the ischemic period. The CO2 gap was determined with an oral tonometry catheter in the stomach (PgCO2) and one placed in the ileum (PiCO2). Time points: Baseline (bl) and 8h after induction of sepsis. Statistics were performed using ANOVA.
Results: The PiCO2 [mmHg] was at study end significantly higher in the RS group [68.8±8.8] compared to HES130 [41.3±14.5], HES700/2.5:1 [40.6±14.5] and control [40.8±8.6]. There were no significant differences in the PgCO2 between the groups [RS 18.0±11.3; HES130 11.0±4.7; HES700/2.5:1 16.8±15.0; HES700/6:1 8.8±6.8; control 8.8±1.3]. StO2 analysis showed no differences in the incSlope and decSlope between the groups. The relative change [% of bl] in StO2 in RS group [33.1±14.8] was significant higher than in control [3.8±1.7].
Conclusion: In this porcine faecal peritonitis model the artificial colloids HES130, HES700/2.5:1 and HES 700/6:1 could maintain tissue oxygenation in the quadriceps muscle significantly better than RS. Additionally microcirculation in the ileum maybe impaired using RS compared to HES13O and HES 700/2.5:1.
Grant acknowledgement. Supported by a grant of B. Braun Melsungen AG, Germany.