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Hypertonic saline solution-hetastarch for fluid resuscitation in experimental septic shock
C W Armistead1, J L Vincent, J C Preiser
1Department of Intensive Care Medicine, Erasme University Hospital, Brussels, Belgium.
Anesthesia and Analgesia
|December 1, 1989
Summary
Hypertonic hydroxyethylstarch (HES) solutions initially improved hemodynamic function in endotoxic shock dogs but these benefits were transient. Hypertonic colloids may offer temporary resuscitation advantages in shock.
Area of Science:
- Veterinary Medicine
- Critical Care Medicine
- Pharmacology
Background:
- Hypertonic colloid solutions are effective for hemorrhagic/traumatic shock resuscitation.
- Endotoxic shock presents significant hemodynamic challenges.
Purpose of the Study:
- To investigate the effects of hypertonic hydroxyethylstarch (HT-HES) versus isotonic HES in canine endotoxic shock.
- To evaluate hemodynamic, gasometric, and metabolic responses to fluid resuscitation.
Main Methods:
- Dogs with endotoxic shock received either HES in 0.9% NaCl or HT-HES in 7.5% NaCl.
- Fluid administration aimed to maintain baseline pulmonary artery balloon-occluded pressure.
- Hemodynamic parameters, oxygen delivery/consumption, and metabolic markers were monitored.
Main Results:
- HT-HES initially improved arterial pressure, cardiac output, and oxygen delivery compared to HES.
- Persistent volume effects led to lower hematocrit and protein levels with HT-HES.
- These initial improvements with HT-HES were transient, diminishing over time.
- HT-HES significantly increased serum sodium and osmolality.
Conclusions:
- While HT-HES provided transient hemodynamic benefits in endotoxic shock, these effects were not sustained.
- The study highlights the temporary nature of hypertonic colloid resuscitation in this model.
- Further research is needed to understand long-term effects and optimal use.