Document Detail

Contrasting effects of colloid and crystalloid resuscitation fluids on cardiac vascular permeability.
MedLine Citation:
PMID:  16732094     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Fluid extravasation may lead to myocardial edema and consequent reduction in ventricular function. Albumin is presumed to interact with the endothelial glycocalyx. The authors' objective was to compare the impact of different resuscitation fluids (human albumin, hydroxyethyl starch, saline) on vascular integrity. METHODS: In an isolated perfused heart model (guinea pig), Krebs-Henseleit buffer was augmented with colloids (one third volume 5% albumin or 6% hydroxyethyl starch 130/0.4) or crystalloid (0.9% saline). Perfusion pressure and vascular fluid filtration (epicardial transudate formation) were assessed at different flow rates. After global, stopped-flow ischemia (37 degrees C, 20 min), hearts were reperfused with the same resuscitation fluid additives. In a second series, the authors applied the respective perfusates after enzymatic digestion of the endothelial glycocalyx (heparinase, 10 U over 15 min). RESULTS: Both 5% albumin and 6% hydroxyethyl starch decreased fluid extravasation versus saline (68.4 +/- 5.9, 134.8 +/- 20.5, and 436.8 +/- 14.7 microl/min, respectively, at 60 cm H(2)O perfusion pressure; P < 0.05), the corresponding colloid osmotic pressures being 2.95, 5.45, and 0.00 mmHg. Digestion of the endothelial glycocalyx decreased coronary integrity in both colloid groups. After ischemia, a transient increase in vascular leak occurred with Krebs-Henseleit buffer containing hydroxyethyl starch and saline, but not with albumin. The authors observed no difference between intravascular and bulk interstitial colloid concentration in the steady state. Notwithstanding, electron microscopy revealed an intact endothelial glycocalyx and no interstitial edema in the albumin group. CONCLUSION: Ex vivo, albumin more effectively prevented fluid extravasation in the heart than crystalloid or artificial colloid. This effect was partly independent of colloid osmotic pressure and may be attributable to an interaction of albumin with the endothelial glycocalyx.
Matthias Jacob; Dirk Bruegger; Markus Rehm; Ulrich Welsch; Peter Conzen; Bernhard F Becker
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Anesthesiology     Volume:  104     ISSN:  0003-3022     ISO Abbreviation:  Anesthesiology     Publication Date:  2006 Jun 
Date Detail:
Created Date:  2006-05-29     Completed Date:  2006-06-29     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1223-31     Citation Subset:  AIM; IM    
Clinic of Anesthesiology, Ludwig-Maximilians University Munich, Germany.
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MeSH Terms
Albumins / pharmacology
Capillary Permeability*
Colloids / pharmacology
Coronary Vessels / metabolism*
Glucose / pharmacology
Guinea Pigs
Heparin Lyase / pharmacology
Hetastarch / pharmacology
Isotonic Solutions / pharmacology
Osmotic Pressure
Tromethamine / pharmacology
Reg. No./Substance:
0/Albumins; 0/Colloids; 0/Isotonic Solutions; 0/Krebs-Henseleit solution; 0/crystalloid solutions; 50-99-7/Glucose; 77-86-1/Tromethamine; 9005-27-0/Hetastarch; EC Lyase

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