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[Cardiorespiratory and microcirculatory effects following volume replacement using a new hydroxyethyl starch
J Boldt1, C Knothe, B Zickmann
1Abteilung Anästhesiologie und operative Intensivmedizin, Justus-Liebig-Universität Giessen.
Der Anaesthesist
|June 1, 1992
Summary
Standard hydroxyethyl starch 200/0.5 (HAES 200) was more effective than the new HAES 130/0.5 in maintaining hemodynamic stability and improving microcirculatory blood flow in cardiac surgery patients. HAES 200 is preferred for volume replacement in this population.
Area of Science:
- Cardiology
- Anesthesiology
- Intensive Care Medicine
Background:
- Maintaining stable hemodynamics is crucial during cardiac surgery, often requiring volume therapy.
- Hydroxyethyl starch (HAES) solutions are commonly used, with varying properties like concentration, molecular weight, and substitution degree.
- Assessing both macrohemodynamic and microcirculatory effects is vital for optimal volume therapy selection.
Purpose of the Study:
- To compare the efficacy of a new 10% HAES 130/0.5 solution against a standard 10% HAES 200/0.5 preparation in cardiac surgery patients.
- To evaluate the impact of these HAES solutions on macrohemodynamics and microcirculatory blood flow.
Main Methods:
- A randomized study involving elective aortocoronary bypass grafting patients with low pulmonary capillary wedge pressure (PCWP).
- Patients received either HAES 130/0.5 or HAES 200/0.5 to double PCWP; a control group received no volume therapy.
- Microcirculatory alterations were assessed using laser Doppler flux (LDF) on the forehead and forearm, alongside hemodynamic monitoring (PCWP, cardiac index, systemic vascular resistance) and laboratory parameters.
Main Results:
- Both HAES solutions increased cardiac index (CI), but the effect was sustained longer with HAES 200.
- HAES 200 induced a more significant decrease in systemic vascular resistance (SVR) compared to HAES 130.
- Microcirculatory blood flow (LDF) increased more with HAES 200, particularly in the post-bypass period, while HAES 130 showed a decrease in LDF post-bypass.
Conclusions:
- The new HAES 130/0.5 solution demonstrated a shorter duration of macrohemodynamic improvement compared to the standard HAES 200/0.5.
- HAES 200 resulted in more pronounced and sustained enhancement of microcirculatory blood flow.
- HAES 200 is considered more effective for volume replacement and is recommended over HAES 130 in cardiac surgery patients.