HIGH-MOLECULAR-WEIGHT HYALURONAN-A POTENTIAL ADJUVANT TO FLUID RESUSCITATION IN ABDOMINAL SEPSIS?

Area of Science:

• Critical Care Medicine
• Biochemistry
• Sepsis Pathophysiology

Background:

• Fluid resuscitation is crucial for sepsis-induced tissue hypoperfusion but excess fluid can increase mortality.
• Hyaluronan, a water-binding glycosaminoglycan, has not been studied as an adjunct in sepsis fluid resuscitation.
• Understanding hyaluronan's role may offer new therapeutic strategies.

Purpose of the Study:

• To investigate the efficacy of hyaluronan as an adjuvant to fluid resuscitation in a porcine model of peritonitis sepsis.
• To determine if hyaluronan reduces fluid administration requirements and/or attenuates the inflammatory response.
• To assess hyaluronan's effect on hyaluronan fragmentation during sepsis.

Main Methods:

• Prospective, parallel-grouped, blinded study in a porcine peritonitis sepsis model (n=8 per group).
• Animals received either adjuvant hyaluronan or 0.9% saline as fluid resuscitation after hemodynamic instability.
• Continuous infusion of hyaluronan (1 mg/kg/h) or saline was administered, monitoring fluid volumes and inflammatory markers like IL-6.

Main Results:

• Total fluid volumes infused were similar between the hyaluronan (17.5 ± 11 mL/kg/h) and saline (19.0 ± 7 mL/kg/h) groups (P=0.442).
• Plasma IL-6 levels did not significantly differ between groups at 18 hours of resuscitation.
• Hyaluronan administration counteracted the sepsis-induced increase in fragmented hyaluronan (16.8 ± 0.9% vs 17.9 ± 0.6%, P=0.031).

Conclusions:

• Hyaluronan did not reduce the volume of fluid required for resuscitation in this sepsis model.
• Hyaluronan did not attenuate the overall inflammatory reaction as measured by IL-6 levels.
• Hyaluronan effectively counterbalanced the peritonitis-induced shift toward increased hyaluronan fragmentation.