Comparison of 6% hydroxyethyl starch 130/0.4 and saline solution for resuscitation of the microcirculation during the early goal-directed therapy of septic patients

Dubin, Arnaldo; Pozo, Mario O.; Casabella, Christian A.; Murias, Gastón; Pálizas, Fernando; Moseinco, Miriam C.; Kanoore Edul, Vanina S.; Pálizas, Fernando; Estenssoro, Elisa; Ince, Can

doi:10.1016/j.jcrc.2010.04.007

« Previous Next »Journal of Critical Care
Volume 25, Issue 4 , Pages 659.e1-659.e8, December 2010

Comparison of 6% hydroxyethyl starch 130/0.4 and saline solution for resuscitation of the microcirculation during the early goal-directed therapy of septic patients☆☆☆

Arnaldo Dubin, MD
- Servicio de Terapia Intensiva, Sanatorio Otamendi y Miroli, Azcuénaga 870, Buenos Aires C1115AAB, Argentina
- Cátedra de Farmacología Aplicada, Facultad de Ciencias Médicas, Universidad Nacional de La Plata, 60 y 120, La Plata 1900, Argentina
- Corresponding author. Servicio de Terapia Intensiva, Sanatorio Otamendi y Miroli, Azcuénaga 870, Buenos Aires C1115AAB, Argentina.
Mario O. Pozo, MD
- Servicio de Terapia Intensiva, Clínica Bazterrica, Juncal 3002, Buenos Aires C1425AYN, Argentina
Christian A. Casabella, MD
- Servicio de Terapia Intensiva, Sanatorio Otamendi y Miroli, Azcuénaga 870, Buenos Aires C1115AAB, Argentina
Gastón Murias, MD
- Servicio de Terapia Intensiva, Clínica Bazterrica, Juncal 3002, Buenos Aires C1425AYN, Argentina
Fernando Pálizas Jr., MD
- Servicio de Terapia Intensiva, Clínica Bazterrica, Juncal 3002, Buenos Aires C1425AYN, Argentina
Miriam C. Moseinco, MD
- Servicio de Terapia Intensiva, Sanatorio Otamendi y Miroli, Azcuénaga 870, Buenos Aires C1115AAB, Argentina
Vanina S. Kanoore Edul, MD
- Servicio de Terapia Intensiva, Sanatorio Otamendi y Miroli, Azcuénaga 870, Buenos Aires C1115AAB, Argentina
- Cátedra de Farmacología Aplicada, Facultad de Ciencias Médicas, Universidad Nacional de La Plata, 60 y 120, La Plata 1900, Argentina
Fernando Pálizas, MD
- Servicio de Terapia Intensiva, Clínica Bazterrica, Juncal 3002, Buenos Aires C1425AYN, Argentina
Elisa Estenssoro, MD
- Servicio de Terapia Intensiva, Hospital San Martín, 1 y 70, La Plata 1900, Argentina
Can Ince, PhD
- Translational Physiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands
- Prof. Ince is Chief Scientific Officer of MicroVision Medical (a university-based company manufacturing sidestream dark field devices) and holds patents and stock related to sidestream dark field imaging. The remaining authors have not disclosed any potential conflicts of interest.

published online 02 September 2010.

Abstract

Purpose

The aim of this study was to show that 6% hydroxyethyl starch (HES) 130/0.4 achieves a better resuscitation of the microcirculation than normal saline solution (SS), during early goal-directed therapy (EGDT) in septic patients.

Materials and Methods

Patients with severe sepsis were randomized for EGDT with 6% HES 130/0.4 (n = 9) or SS (n = 11). Sublingual microcirculation was evaluated by sidestream dark field imaging 24 hours after the beginning of EGDT.

Results

On admission, there were no differences in Sequential Organ Failure Assessment score, mean arterial pressure, lactate, or central venous oxygen saturation. After 24 hours, no difference arose in those parameters. Sublingual capillary density was similar in both groups (21 ± 8 versus 20 ± 3 vessels/mm²); but capillary microvascular flow index, percent of perfused capillaries, and perfused capillary density were higher in 6% HES 130/0.4 (2.5 ± 0.5 versus 1.6 ± 0.7, 84 ± 15 versus 53 ± 26%, and 19 ± 6 versus 11 ± 5 vessels/mm², respectively, P < .005).

Conclusions

Fluid resuscitation with 6% HES 130/0.4 may have advantages over SS to improve sublingual microcirculation. A greater number of patients would be necessary to confirm these findings.

Keywords: Sepsis, Fluid therapy, Microcirculation