Haemodynamic, acid–base and electrolyte changes during plasma replacement with hydroxyethyl starch or crystalloid solution in young pigs

Abstract

We investigated haemodynamic, acid-base and electrolyte changes during almost total plasma replacement with hydroxyethyl starch (HES) and physiological balanced electrolyte solution (PBE) by using a cell saver in ten young pigs. In the PBE group an additional 3550 (444) ml crystalloid solution [Mean (SD)] was infused over the course of the study in order to maintain pulmonary capillary wedge pressure. Plasma protein levels decreased in both groups and the colloid osmotic pressure increased in HES and decreased in PBE. At the end of the study, body weight [HES 10.4 (1), PBE 13.1 (1.4) kg, P < 0.01] and lactic acid concentration [HES 0.9 (0.3), PBE 2.9 (1. 3) mmol.l -1, P < 0.01] was higher and tissue oxygen delivery [HES 327 (22), PBE 89 (29) ml.min.m2, P < 0.01] was lower in the PBE group. There were only moderate acid-base changes in both groups, but at the end, anion gap was significant lower in HES. In conclusion, maintenance of colloid osmotic pressure close to the physiological range of infants seems to be advantageous during major paediatric surgery.

Hydroxyethyl starch and modified fluid gelatin maintain plasma volume in a porcine model of septic shock with capillary leakage

“…This may be due to the infusion of HES, MFG4% and MFG8% as these solutions are hyperoncotic in pigs [30]. Nevertheless the increased COP indicated better intravascular persistency of the HES, MFG4% and MFG8% solutions during sepsis than with RS.…”

Terminal complement complex in septic shock with capillary leakage

“…Whereas in septic patients a reduced colloid osmotic pressure has been reported [20], in our study it has increased in both groups. This may be due to the fact that commercially available iso-oncotic starches are hyperoncotic in pigs [21]. We could show massive deposition of TCC in kidney biopsies of septic animals, indicating complement activation.…”

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“…Today, crystalloid is firstly preferred due to low cost and the lack of coagulation, anaphylactic and infection risk. After administration of a total of 30-50 ml/kg of crystalloid solution or colloid solutions, it is important to observe intravascular osmotic pressure [14]. There are comparably fewer data to confirm the safety use of synthetic colloids (hydroxyethyl starches; HESs, gelatins and dextrans) in children than the data in in adults.…”

“…The 5% albumin solution is osmotically equivalent to plasma [15]. Recently, HES (130/0:42/6:1) has been used for volume replacement in neonates and small infants in cardiac surgery [14,15]. However, colloids have adverse effects on coagulation in children with bleeding problems and in some studies it is stated that they disrupt capillary leakage in septic newborns [15].…”