Document Detail


Effects of Intravascular Volume Replacement on Lung and Kidney Function and Damage in Nonseptic Experimental Lung Injury.
MedLine Citation:
PMID:  23268840     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND:: Intravascular volume replacement is often required in the presence of increased pulmonary capillary leakage, for example in patients with volutrauma with major hemorrhage. In the present study, the effects of Ringer's acetate (RA), gelatin-polysuccinate (GEL), and a modern hydroxyethyl starch (HES, 6% 130/0.42) on lung and kidney function and damage were compared in a two-hit model of acute lung injury. The authors hypothesized that GEL and HES, compared to RA: (1) reduced lung histological damage, (2) impaired kidney morphology and function. METHODS:: Acute lung injury was induced in 30 anesthetized pigs by tidal volumes approximately 40 ml/kg, after saline lung lavage. Protective ventilation was initiated and approximately≈25% of estimated blood volume was drawn. Animals were randomly assigned to receive RA, GEL, or HES (n = 10/group) aimed at approximately 90% of intrathoracic blood volume before blood drainage. RESULTS:: Fluid volumes were higher with RA (2,250 ± 764 ml) than GEL (704 ± 159 ml) and HES (837 ± 82 ml) (P < 0.05). Compared to RA, HES reduced diffuse alveolar damage overall, and GEL in nondependent zones only. GEL and HES yielded lower wet-to-dry ratios compared to RA (6.5 ± 0.5 and 6.5 ± 0.6 vs. 7.9 ± 0.9, respectively, P < 0.05). HES and RA resulted in less kidney damage than GEL, but kidney function did not differ significantly among groups. Compared to GEL, HES yielded lower lung elastance (55 ± 12 vs. 45 ± 13 cm H2O/l, P < 0.05) and intra-abdominal pressure (15 ± 5 vs. 11 ± 4 cm H2O, P < 0.05). CONCLUSIONS:: In this model of acute lung injury, intravascular volume expansion after major hemorrhage with HES yielded less lung damage than RA and less kidney damage than GEL.
Authors:
Pedro L Silva; Andreas Güldner; Christopher Uhlig; Nadja Carvalho; Alessandro Beda; Ines Rentzsch; Michael Kasper; Bärbel Wiedemann; Peter M Spieth; Thea Koch; Vera L Capelozzi; Paolo Pelosi; Patricia R M Rocco; Marcelo Gama de Abreu
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-12-21
Journal Detail:
Title:  Anesthesiology     Volume:  -     ISSN:  1528-1175     ISO Abbreviation:  Anesthesiology     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
*Professor and Chair, Department of Anesthesiology and Intensive Care Medicine, University Hospital Dresden University of Technology, Dresden, Germany. †M.D. and Resident Anesthesiologist and Research Fellow, Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Medicine, University Hospital Dresden University of Technology, Dresden, Germany. ‡Research Fellow, Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Medicine, University Hospital Dresden. §Assistant Professor, Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Medicine, University Hospital Dresden and Postgraduate Electrical Engineering Program, Federal University of Pará, Belém. ║Laboratory Staff, Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Medicine, University Hospital Dresden. #Professor, Institute of Anatomy. **Senior Statistician, Associate Professor, Institute for Medical Informatics and Biometry, Dresden University of Technology, Dresden, Germany. ††Resident Anesthesiologist, Research Fellow, Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Medicine, University Hospital Dresden. ‡‡Professor and Chair, Department of Anesthesiology and Intensive Care Medicine, University Hospital Dresden University of Technology, Dresden, Germany. ║║Professor, Department of Pathology, Faculty of Medicine, University of São Paulo, São Paulo. ##Professor, Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, IRCCS San Martino -IST, Genoa, Italy. ***Professor, Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. ††† Professor, Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Medicine, University Hospital Dresden.
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