The effect of hydroxyethyl starch 6% 130/0.4 compared with gelatin on microvascular reactivity

Abstract

SummaryWe compared the effects on microvascular reactivity of hydroxyethylstarch (Volulyte â ) and gelatin (Geloplasma â ) during acute haemodilution. The hypothesis was that Volulyte would provide better microvascular reactivity than Geloplasma. Forty patients undergoing elective cardiac surgery were randomly assigned to receive either Volulyte or Geloplasma as the exclusive priming solution of the cardiopulmonary bypass. To evaluate microvascular reactivity, postocclusive reactive hyperaemia was examined before and after cardiopulmonary bypass. Microvascular reactivity assessments included the rate of the occlusion and reperfusion slopes and reperfusion times. After cardiopulmonary bypass, increases in reperfusion time were significantly smaller in the Volulyte group (3 (À27 to 9 [À35 to 33]%) vs 29 (À17 to 76 [À34 to 137]%) in the Geloplasma group, p = 0.02 between groups). Rate of reperfusion increased in the Volulyte group (26 (À17 to 43 [À59 to 357])%), whereas it decreased in the Geloplasma group (À22 (À47 to 16 [À84 to 113])%), p = 0.02 between groups. The shorter reperfusion times and increased reperfusion rate suggest that Volulyte maintains better microvascular reactivity than Geloplasma.

The effects of hydroxyethyl starch and gelatine on pulmonary cytokine production and oedema formation

“…Perfusate oncotic pressure is usually adjusted by addition of high molecular weight components such as HES or gelatine that should secure a stable preparation and minimise cytokine production and oedema formation. The setting of IPL is similar to the situation after extracorporeal circulation in cardiac surgery with dilution of the blood volume with up to 1.5 liters of gelatine or HES containing fluids 2 , 18 , 19 .…”

Microvascular reactivity and endothelial glycocalyx degradation when administering hydroxyethyl starch or crystalloid during off‐pump coronary artery bypass graft surgery: a randomised trial

“…Thus, monitoring microvascular reactivity could be a useful method for guiding fluid therapy . In a study by Moerman et al , the authors evaluated HES and gelatin as priming solutions for the cardiopulmonary bypass circuit. They concluded that HES 130/0.4 maintains better microvascular reactivity than gelatin during acute haemodilution.…”

Colloids Versus Crystalloids: Is That the Real Problem?

“…The best fluid resuscitation strategy after cardiac surgery and, generally speaking, in critical patients, is still a topic of great debate, with contrasting results. 14,15 Perhaps the key point is not which fluid to administer, but timing of administration, selection of patients, and global dose of fluids together with the monitoring systems used to guide fluid resuscitation. Indications, monitoring, and timing of fluid administration should be addressed precisely in a well-powered, focused trial.…”