Document Detail

Tetrastarch sustains pulmonary microvascular perfusion and gas exchange during systemic inflammation.
MedLine Citation:
PMID:  21926574     Owner:  NLM     Status:  Publisher    
OBJECTIVE:: According to Fick's law of diffusion, gas exchange depends on the size and thickness of the blood perfused alveolocapillary membrane. Impairment of either one is tenuous. No data are available concerning the impact of hydroxyethyl starches and saline on pulmonary microperfusion and gas exchange during systemic inflammation. DESIGN:: Prospective, randomized, controlled experimental study. SETTING:: University research laboratory. SUBJECTS:: Thirty-two anesthetized rabbits assigned to four groups (n = 8). INTERVENTIONS:: Except for the control group, systemic inflammation was induced by lipopolysaccharide. Fluid resuscitation was performed with saline alone or in conjunction with tetrastarch or pentastarch. Pulmonary microcirculation was analyzed at 0 hr and 2 hrs using intravital microscopy. Thickness of the alveolocapillary membrane was measured using electron microscopy. MEASUREMENTS AND MAIN RESULTS:: Macrohemodynamics were stable in all groups. In pulmonary arterioles, lipopolysaccharide reduced the erythrocyte velocity and impeded the microvascular decrease of the hematocrit in the saline and pentastarch group. In contrast, infusion of tetrastarch normalized these perfusion parameters. In capillaries, lipopolysaccharide decreased the functional capillary segment density and the capillary perfusion index, which was prevented by both starches. However, compared with saline and pentastarch, treatment with tetrastarch prevented the lipopolysaccharide-induced reduction of the capillary erythrocyte flux and inversely reduced the erythrocyte capillary transit time. Thickening of alveolocapillary septae after lipopolysaccharide application was solely observed in the saline and pentastarch group. In contrast to pentastarch and saline, the application of tetrastarch prevented the lipopolysaccharide-induced increase of the alveoloarterial oxygen difference. CONCLUSIONS:: Tetrastarch sustains pulmonary gas exchange during experimental systemic inflammation more effectively than saline and pentastarch by protecting the diffusion distance and the size of the microvascular gas exchange surface. Improved capillary perfusion resulting from tetrastarch therapy, which is typically applied to increase blood pressure, may according to the Ohm's law locally decrease hydrostatic perfusion pressures in the pulmonary microvasculature during systemic inflammation.
Kai Heckel; Bjoern Winkelmann; Mike S Strunden; Annika Basedow; Anke Schuster; Udo Schumacher; Rainer Kiefmann; Daniel A Reuter; Alwin E Goetz
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-9-15
Journal Detail:
Title:  Critical care medicine     Volume:  -     ISSN:  1530-0293     ISO Abbreviation:  -     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-9-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
From the Department of Anesthesiology (KH, BW, MSS, AB, AS, RK, DAR, AEG), the Cardiovascular Research Center (KH, MSS, AS, RK, DAR, AEG), and the Department of Anatomy II: Experimental Morphology (US), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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