Hypertonic hydroxyethyl starch restores hepatic microvascular perfusion in hemorrhagic shock

Small volume hypertonic hydroxyethyl starch reduces acute microvascular dysfunction after closed soft-tissue trauma

“…Systemic haemodynamics and blood parameters. Contrary to previous studies of traumatic haemorrhagic shock and hypotension in which hypertonic-hyperosmotic solutions were shown rapidly and efficiently to restore severely depressed macrohaemodynamics, 8,12,13,25 in our study the mean arterial blood pressure and heart rate were not affected by infusion of HS/HES. Normovolaemic conditions and the missing systemic fluid imbalance between the intra-and extracellular space have already been discussed as possible factors accounting for the lack of macrohaemodynamic changes.…”

“…The apparently negative side-effect of a significantly decreased pH in the HS/HES group is thought to be related to a hyperchloraemic metabolic acidosis 16 since lactate levels and arterial blood gases were within the normal range and did not differ between groups. The observation that hypertonic-hyperosmotic infusions are detrimental under some circumstances, 27 yet protective in others 8,12,13,25 indicates potential risks of treatment with such fluids. These are specifically relevant in critically injured, dehydrated and high-risk patients 28 and seem to be related to an increased plasma osmolarity and hypokalaemia causing cardiac arrhythmia and a metabolic acidosis induced by an increased plasma chloride anion load, thereby augmenting pre-existing acidosis.…”

“…9,29 In our study, however, lumenal capillary diameters were found to be unchanged in response to HS/HES. This suggests that the cellular basis of the HS/HES-mediated protection of the post-traumatic microcirculation differs partly from the HS/HES-induced mechanisms responsible for reversal of shock- 8,9 or ischaemia-induced capillary dysfunction. 26,29 Previous studies have shown that although endothelial integrity is deranged immediately after closed soft-tissue injury, microvascular permeability displays a gradual increase with significant peak levels not earlier than 24 hours after injury.…”

Small volume hypertonic hydroxyethyl starch reduces acute microvascular dysfunction after closed soft-tissue trauma

“…Systemic haemodynamics and blood parameters. Contrary to previous studies of traumatic haemorrhagic shock and hypotension in which hypertonic-hyperosmotic solutions were shown rapidly and efficiently to restore severely depressed macrohaemodynamics, 8,12,13,25 in our study the mean arterial blood pressure and heart rate were not affected by infusion of HS/HES. Normovolaemic conditions and the missing systemic fluid imbalance between the intra-and extracellular space have already been discussed as possible factors accounting for the lack of macrohaemodynamic changes.…”

“…The apparently negative side-effect of a significantly decreased pH in the HS/HES group is thought to be related to a hyperchloraemic metabolic acidosis 16 since lactate levels and arterial blood gases were within the normal range and did not differ between groups. The observation that hypertonic-hyperosmotic infusions are detrimental under some circumstances, 27 yet protective in others 8,12,13,25 indicates potential risks of treatment with such fluids. These are specifically relevant in critically injured, dehydrated and high-risk patients 28 and seem to be related to an increased plasma osmolarity and hypokalaemia causing cardiac arrhythmia and a metabolic acidosis induced by an increased plasma chloride anion load, thereby augmenting pre-existing acidosis.…”

“…9,29 In our study, however, lumenal capillary diameters were found to be unchanged in response to HS/HES. This suggests that the cellular basis of the HS/HES-mediated protection of the post-traumatic microcirculation differs partly from the HS/HES-induced mechanisms responsible for reversal of shock- 8,9 or ischaemia-induced capillary dysfunction. 26,29 Previous studies have shown that although endothelial integrity is deranged immediately after closed soft-tissue injury, microvascular permeability displays a gradual increase with significant peak levels not earlier than 24 hours after injury.…”

Pentastarch in a Balanced Solution Reduces Hepatic Leukocyte Recruitment in Early Sepsis

“…In a hemorrhagic shock model, the use of hydroxyethyl starches improved sinusoidal perfusion compared to lactated Ringer's. However, there was no significant difference between the starch solutions and Ringer's in terms of leukocyte recruitment (36), a finding similar to that in our study. We have demonstrated that the addition of pentastarch to normal saline reduces the inflammation.…”

Hypertonic Saline- Hydroxyethyl Starch In Trauma Resuscitation

“…In contrast to isotonic solutions, HS-HES prevents intravascular leukocyte adherence (19) and attenuates the immunomodulatory response. Studies also show that both HS and HS-HES improve regional blood flow to vital organs.…”

Small volume hypertonic hydroxyethyl starch reduces acute microvascular dysfunction after closed soft-tissue trauma

“…Systemic haemodynamics and blood parameters. Contrary to previous studies of traumatic haemorrhagic shock and hypotension in which hypertonic-hyperosmotic solutions were shown rapidly and efficiently to restore severely depressed macrohaemodynamics, 8,12,13,25 in our study the mean arterial blood pressure and heart rate were not affected by infusion of HS/HES. Normovolaemic conditions and the missing systemic fluid imbalance between the intra-and extracellular space have already been discussed as possible factors accounting for the lack of macrohaemodynamic changes.…”

“…The apparently negative side-effect of a significantly decreased pH in the HS/HES group is thought to be related to a hyperchloraemic metabolic acidosis 16 since lactate levels and arterial blood gases were within the normal range and did not differ between groups. The observation that hypertonic-hyperosmotic infusions are detrimental under some circumstances, 27 yet protective in others 8,12,13,25 indicates potential risks of treatment with such fluids. These are specifically relevant in critically injured, dehydrated and high-risk patients 28 and seem to be related to an increased plasma osmolarity and hypokalaemia causing cardiac arrhythmia and a metabolic acidosis induced by an increased plasma chloride anion load, thereby augmenting pre-existing acidosis.…”

“…9,29 In our study, however, lumenal capillary diameters were found to be unchanged in response to HS/HES. This suggests that the cellular basis of the HS/HES-mediated protection of the post-traumatic microcirculation differs partly from the HS/HES-induced mechanisms responsible for reversal of shock- 8,9 or ischaemia-induced capillary dysfunction. 26,29 Previous studies have shown that although endothelial integrity is deranged immediately after closed soft-tissue injury, microvascular permeability displays a gradual increase with significant peak levels not earlier than 24 hours after injury.…”

Pentastarch in a Balanced Solution Reduces Hepatic Leukocyte Recruitment in Early Sepsis

“…In a hemorrhagic shock model, the use of hydroxyethyl starches improved sinusoidal perfusion compared to lactated Ringer's. However, there was no significant difference between the starch solutions and Ringer's in terms of leukocyte recruitment (36), a finding similar to that in our study. We have demonstrated that the addition of pentastarch to normal saline reduces the inflammation.…”

Hypertonic Saline- Hydroxyethyl Starch In Trauma Resuscitation

“…In contrast to isotonic solutions, HS-HES prevents intravascular leukocyte adherence (19) and attenuates the immunomodulatory response. Studies also show that both HS and HS-HES improve regional blood flow to vital organs.…”

Small volume hypertonic hydroxyethyl starch reduces acute microvascular dysfunction after closed soft-tissue trauma

“…Systemic haemodynamics and blood parameters. Contrary to previous studies of traumatic haemorrhagic shock and hypotension in which hypertonic-hyperosmotic solutions were shown rapidly and efficiently to restore severely depressed macrohaemodynamics, 8,12,13,25 in our study the mean arterial blood pressure and heart rate were not affected by infusion of HS/HES. Normovolaemic conditions and the missing systemic fluid imbalance between the intra-and extracellular space have already been discussed as possible factors accounting for the lack of macrohaemodynamic changes.…”

“…The apparently negative side-effect of a significantly decreased pH in the HS/HES group is thought to be related to a hyperchloraemic metabolic acidosis 16 since lactate levels and arterial blood gases were within the normal range and did not differ between groups. The observation that hypertonic-hyperosmotic infusions are detrimental under some circumstances, 27 yet protective in others 8,12,13,25 indicates potential risks of treatment with such fluids. These are specifically relevant in critically injured, dehydrated and high-risk patients 28 and seem to be related to an increased plasma osmolarity and hypokalaemia causing cardiac arrhythmia and a metabolic acidosis induced by an increased plasma chloride anion load, thereby augmenting pre-existing acidosis.…”

“…9,29 In our study, however, lumenal capillary diameters were found to be unchanged in response to HS/HES. This suggests that the cellular basis of the HS/HES-mediated protection of the post-traumatic microcirculation differs partly from the HS/HES-induced mechanisms responsible for reversal of shock- 8,9 or ischaemia-induced capillary dysfunction. 26,29 Previous studies have shown that although endothelial integrity is deranged immediately after closed soft-tissue injury, microvascular permeability displays a gradual increase with significant peak levels not earlier than 24 hours after injury.…”

Pentastarch in a Balanced Solution Reduces Hepatic Leukocyte Recruitment in Early Sepsis

“…In a hemorrhagic shock model, the use of hydroxyethyl starches improved sinusoidal perfusion compared to lactated Ringer's. However, there was no significant difference between the starch solutions and Ringer's in terms of leukocyte recruitment (36), a finding similar to that in our study. We have demonstrated that the addition of pentastarch to normal saline reduces the inflammation.…”

Hypertonic Saline- Hydroxyethyl Starch In Trauma Resuscitation

“…In contrast to isotonic solutions, HS-HES prevents intravascular leukocyte adherence (19) and attenuates the immunomodulatory response. Studies also show that both HS and HS-HES improve regional blood flow to vital organs.…”