Assessment of hemodynamic and gastric mucosal acidosis with modified fluid gelatin versus 6% hydroxyethyl starch: a prospective, randomized study

Asfar, Pierre; Kerkeni, Nadia; Labadie, François; Gouëllo, J. P.; Brenet, O.; Alquier, P

doi:10.1007/s001340000606

Cited by 44 publications

(21 citation statements)

References 31 publications

(34 reference statements)

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“…That dextran has a better plasma volume-expanding effect than albumin has been demonstrated previously (41), as has the similarly large plasma volume expansion seen for gelatin and HES at increased permeability during endotoxicosis (22) and at normal permeability (26). In two clinical studies on patients in intensive care, there was no difference in hemodynamic stability between a fixed bolus infusion of gelatin and of HES (27,42), but gastric mucosal pH was lower after HES 130/0.4 infusion than after gelatin infusion (42). A recent clinical study has shown equal plasma expansion with HES 200/0.5 and with gelatin (30).…”

Section: Discussionmentioning

confidence: 79%

Plasma volume expansion and transcapillary fluid exchange in skeletal muscle of albumin, dextran, gelatin, hydroxyethyl starch, and saline after trauma in the cat*

Persson

Grände

2006

Critical Care Medicine

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Section: Discussionmentioning

confidence: 79%

Plasma volume expansion and transcapillary fluid exchange in skeletal muscle of albumin, dextran, gelatin, hydroxyethyl starch, and saline after trauma in the cat*

Persson

Grände

2006

Critical Care Medicine

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“…In hydroxyethyl starch treated patients cardiac index, oxygen delivery and consumption increased, and gastric intramucosal pH (pHi) remained stable whereas it decreased in albumin treated patients. In three other studies [20-22] conducted in patients with sepsis and septic shock, fluid challenges performed with hydroxyethyl starch neither altered the P CO 2 gap nor influenced splanchnic haemodynamics. Moreover, a randomized comparison of hydroxyethyl starch and gelatin in haemodynamically stable septic patients revealed a beneficial effect of gelatin on the P CO 2 gap [20].…”

Section: Therapeutic Strategiesmentioning

confidence: 92%

“…In three other studies [20-22] conducted in patients with sepsis and septic shock, fluid challenges performed with hydroxyethyl starch neither altered the P CO 2 gap nor influenced splanchnic haemodynamics. Moreover, a randomized comparison of hydroxyethyl starch and gelatin in haemodynamically stable septic patients revealed a beneficial effect of gelatin on the P CO 2 gap [20]. These studies suggested no better effect of one colloid over the others on splanchnic haemodynamics, and the use of colloids must be weighed against their side effects [23].…”

Section: Therapeutic Strategiesmentioning

confidence: 92%

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et al. 2003

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170 ICG = indocyanine green; ICU = intensive care unit; MEGX = monoethylglycinexylidide; NAC = N-acetyl cysteine; PCO 2 = partial carbon dioxide tension; pHi = intramucosal pH. Critical Care June 2004 Vol 8 No 3 Asfar et al. IntroductionResearch interest has focused on the intestinal and hepatic circulations in various models of shock, and particularly in septic shock. The splanchnic area is reported to be the 'motor' of multiple organ failure [1] and the 'canary' of the body [2]. In fact, because of its peculiar vascular anatomy, the hepatosplanchnic area is jeopardized during septic shock, which may potentially lead to a vicious circle of inflammatory responses, culminating in multiple organ failure syndrome.The present clinical review briefly discusses the splanchnic vascular anatomy and focuses on the different therapeutic approaches that have been proposed to promote perfusion of the gastrointestinal tract during resuscitation of patients with septic shock. When possible and reasonable, we propose therapeutic recommendations.References were obtained from Medline database (from the earliest records to 2003). We used the following keywords: gastric mucosal pH or pHi, splanchnic, haemodynamics, microcirculation, sepsis, septic shock, vasoactive drugs, dobutamine, dopamine, norepinephrine, epinephrine, dopexamine vasopressin, terlipressin, prostacyclin, N-acetyl cysteine, dialysis and haemofiltration. We also reviewed the reference lists of all available review articles and primary studies to identify references not found in computerized searches. We placed emphasis on prospective, randomized, controlled clinical trials. Anatomy of hepato-splanchnic vascular bedThe splanchnic vasculature includes both serial and parallel vascular beds (Fig. 1) AbstractThe organs of the hepato-splanchnic system are considered to play a key role in the development of multiorgan failure during septic shock. Impaired oxygenation of the intestinal mucosa can lead to disruption of the intestinal barrier, which may promote a vicious cycle of inflammatory response, increased oxygen demand and inadequate oxygen supply. Standard septic shock therapy includes supportive treatment such as fluid resuscitation, administration of vasopressors (adrenergic and nonadrenergic drugs), and respiratory and renal support. These therapies may have beneficial or detrimental effects not only on systemic haemodynamics but also on splanchnic haemodynamics, at both the macrocirculatory and microcirculatory levels. This clinical review focuses on the splanchnic haemodynamic and metabolic effects of standard therapies used in patients with septic shock, as well as on the recently described nonconventional therapies such as vasopressin, prostacyclin and N-acetyl cysteine.

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“…However, other studies have already reported inconstant improvement of microcirculatory gastric perfusion evaluated by gastric tonometry (gastric pHi), despite a clear improvement in CO following fluid loading in septic-shock patients [9,10] and in postoperative cardiac surgery [11]. Intravenous fluid therapy was guided by measurements of central venous pressure (CVP group) or stroke volume (SV group).…”

Section: Fluid Resuscitationmentioning

confidence: 99%

Targeting the microcirculation in resuscitation of acutely unwell patients

Harrois

Dupic

Duranteau

2011

Current Opinion in Critical Care

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Microcirculatory hemodynamics have to be restored as soon as possible during the early phase of the management of acutely unwell patients. Future trials should test whether microcirculation-guided strategy could better improve organ dysfunction than global hemodynamic-guided strategy. An optimal resuscitation has to restore the systematic hemodynamics and make sure of the quality of the microcirculation.

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Assessment of hemodynamic and gastric mucosal acidosis with modified fluid gelatin versus 6% hydroxyethyl starch: a prospective, randomized study

Abstract: Although MFG and 6% HES have the same hemodynamic effects, their physicochemical properties induce different responses on gastric mucosal acidosis in septic, hypovolemic and ventilated patients. These effects of MFG and HES on gastric mucosa need to be considered in patient management.

Cited by 44 publications

References 31 publications

Plasma volume expansion and transcapillary fluid exchange in skeletal muscle of albumin, dextran, gelatin, hydroxyethyl starch, and saline after trauma in the cat*

Plasma volume expansion and transcapillary fluid exchange in skeletal muscle of albumin, dextran, gelatin, hydroxyethyl starch, and saline after trauma in the cat*

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Targeting the microcirculation in resuscitation of acutely unwell patients

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