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

      Affiliations

    • 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 InformationCorresponding author. Servicio de Terapia Intensiva, Sanatorio Otamendi y Miroli, Azcuénaga 870, Buenos Aires C1115AAB, Argentina.
    • ,
  • Mario O. Pozo, MD

      Affiliations

    • Servicio de Terapia Intensiva, Clínica Bazterrica, Juncal 3002, Buenos Aires C1425AYN, Argentina
    • ,
  • Christian A. Casabella, MD

      Affiliations

    • Servicio de Terapia Intensiva, Sanatorio Otamendi y Miroli, Azcuénaga 870, Buenos Aires C1115AAB, Argentina
    • ,
  • Gastón Murias, MD

      Affiliations

    • Servicio de Terapia Intensiva, Clínica Bazterrica, Juncal 3002, Buenos Aires C1425AYN, Argentina
    • ,
  • Fernando Pálizas Jr., MD

      Affiliations

    • Servicio de Terapia Intensiva, Clínica Bazterrica, Juncal 3002, Buenos Aires C1425AYN, Argentina
    • ,
  • Miriam C. Moseinco, MD

      Affiliations

    • Servicio de Terapia Intensiva, Sanatorio Otamendi y Miroli, Azcuénaga 870, Buenos Aires C1115AAB, Argentina
    • ,
  • Vanina S. Kanoore Edul, MD

      Affiliations

    • 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

      Affiliations

    • Servicio de Terapia Intensiva, Clínica Bazterrica, Juncal 3002, Buenos Aires C1425AYN, Argentina
    • ,
  • Elisa Estenssoro, MD

      Affiliations

    • Servicio de Terapia Intensiva, Hospital San Martín, 1 y 70, La Plata 1900, Argentina
    • ,
  • Can Ince, PhD

      Affiliations

    • 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.

References 

  1. Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med. 2001;345:1368–1377
  2. Dellinger RP, Levy MM, Carlet JM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med. 2008;34:17–60
  3. Trzeciak S, Dellinger RP, Parrillo JE, et al. Early microcirculatory perfusion derangements in patients with severe sepsis and septic shock: relationship to hemodynamics, oxygen transport, and survival. Ann Emerg Med. 2007;49:88–98
  4. Trzeciak S, McCoy JV, Phillip Dellinger R, et al. Early increases in microcirculatory perfusion during protocol-directed resuscitation are associated with reduced multi-organ failure at 24 h in patients with sepsis. Intensive Care Med. 2008;34:2210–2217
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  16. Sakr Y, Dubois MJ, De Backer D, et al. Persistent microcirculatory alterations are associated with organ failure and death in patients with septic shock. Crit Care Med. 2004;32:1825–1831
  17. De Backer D, Creteur J, Dubois MJ, et al. The effects of dobutamine on microcirculatory alterations in patients with septic shock are independent of its systemic effects. Crit Care Med. 2006;34:403–408
  18. Ince C. The microcirculation is the motor of sepsis. Critical Care. 2005;9(Suppl 4):S13–19
  19. Rivers EP, Kruse JA, Jacobsen G, et al. The influence of early hemodynamic optimization on biomarker patterns of severe sepsis and septic shock. Crit Care Med. 2007;35:2016–2024
  20. Boldt J, Ducke M, Kumle B, et al. Influence of different volume replacement strategies on inflammation and endothelium activation in the elderly undergoing major abdominal surgery. Intensive Care Med. 2004;30:416–422
  21. Allison KP, Gosling P, Jones S, et al. Randomized trial of hydroxyethyl starch versus gelatine for trauma resuscitation. J Trauma. 1999;47:1114–1121
  22. Handrigan MT, Burns AR, Donnachie EM, et al. Hydroxyethyl starch inhibits neutrophil adhesion and transendothelial cell migration. Shock. 2005;24:434–439
  23. Schäper J, Ahmed R, Schäfer T, et al. Volume therapy with colloid solutions preserves intestinal microvascular perfusion in endotoxaemia. Resuscitation. 2008;76:120–128
  24. Küpper S, Mees ST, Gassmann P, et al. Hydroxyethyl starch normalizes platelet and leukocyte adhesion within pulmonary microcirculation during LPS-induced endotoxemia. Shock. 2007;28:300–308
  25. Neff TA, Fischler L, Mark M, et al. The influence of two different hydroxyethyl starch solutions (6% HES 130/0.4 and 200/0.5) on blood viscosity. Anesth Analg. 2005;100:1773–1780
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  29. Zakaria E, Li N, Matheson P, et al. Cellular edema regulates tissue capillary perfusion after hemorrhage resuscitation. Surgery. 2007;142:487–496
  30. Brunkhorst FM, Engel C, Bloos F, et al. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med. 2008;358:125–139

☆ Trial registration: The study was registered in ClinicalTrials.gov. ClinicalTrials.gov Identifier: NCT00799916.

☆☆ Supported by the grant PICT-2007-00912, Agencia Nacional de Promoción Científica y Tecnológica, Argentina.

PII: S0883-9441(10)00090-0

doi: 10.1016/j.jcrc.2010.04.007

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

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