This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (63) Citing Articles via Google Scholar Google Scholar Articles by Lang, K. Articles by Haisch, G. Search for Related Content PubMed PubMed Citation Articles by Lang, K. Articles by Haisch, G. Related Collections Critical Care Blood

---

CRITICAL CARE AND TRAUMA

Colloids Versus Crystalloids and Tissue Oxygen Tension in Patients Undergoing Major Abdominal Surgery

Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany

Address correspondence and reprint requests to Prof. Dr. med. Joachim Boldt, Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Bremserstr. 79, D-67063 Ludwigshafen, Germany. Address e-mail to BoldtJ @gmx.net.

The effects of intravascular volume replacement regimens on tissue oxygen tension (ptiO₂) are not definitely known. Forty-two consecutive patients scheduled for elective major abdominal surgery were prospectively randomized to receive either 6% hydroxyethyl starch (HES) (mean molecular weight 130 kd, degree of substitution 0.4, n = 21) or lactated Ringer’s solution (RL, n = 21) for intravascular volume replacement. Fluids were administered perioperatively and continued for 24 h on the intensive care unit to keep central venous pressure between 8 and 12 mm Hg. The ptiO₂ was measured continuously in the left deltoid muscle by using microsensoric implantable partial pressure of oxygen catheters after the induction of anesthesia (baseline, T0), 60 min (T1) and 120 min thereafter (T2), at the end of surgery (T3), and on the morning of the first postoperative day on the intensive care unit (T4). HES 130/0.4 2920 ± 360 mL and 11,740 ± 2,630 mL of RL were given to the patients within the study period. Systemic hemodynamics and oxygenation (PaO₂, PaCO₂) did not differ significantly between the two volume groups throughout the study. From similar baseline values, ptiO₂ increased significantly in the HES-treated patients (a maximum of 59% at T4), whereas it decreased in the RL group (a maximum of -23% at T4, P < 0.05). The largest differences of ptiO₂ were measured on the morning of the first postoperative day. We conclude that intravascular volume replacement with 6% HES 130/0.4 improved tissue oxygenation during and after major surgical procedures compared with a crystalloid-based volume replacement strategy. Improved microperfusion and less endothelial swelling may be responsible for the increase in ptiO₂ in the HES 130/0.4-treated patients.

IMPLICATIONS: In patients undergoing major abdominal surgery, a colloid-based (with hydroxyethyl starch [HES] 130/0.4) and a crystalloid-based (with lactated Ringer’s solution [RL]) volume replacement regimen was compared regarding tissue oxygen tension (ptiO₂) measured continuously by microsensoric implantable catheters. The ptiO₂ increased in the HES-treated (+59%) but decreased in the RL-treated (-23%) patients. Improved microcirculation may be the mechanism for the better ptiO₂ in the HES group.

This article has been cited by other articles:

				J. Joseph, A. Sinha, M. Paech, and B. N J Walters Sepsis in pregnancy and early goal-directed therapy Obstet Med, September 1, 2009; 2(3): 93 - 99. [Abstract] [Full Text] [PDF]

				J. Boldt Seven misconceptions regarding volume therapy strategies--and their correction Br. J. Anaesth., August 1, 2009; 103(2): 147 - 151. [Full Text] [PDF]

				M. R. Concha, V. F. Mertz, L. I. Cortinez, K. A. Gonzalez, J. M. Butte, F. Lopez, G. Pinedo, and A. Zuniga The Volume of Lactated Ringer's Solution Required to Maintain Preload and Cardiac Index During Open and Laparoscopic Surgery Anesth. Analg., February 1, 2009; 108(2): 616 - 622. [Abstract] [Full Text] [PDF]

				J. Boldt, C. Brosch, K. Rohm, A. Lehmann, A. Mengistu, and S. Suttner Is Albumin Administration in Hypoalbuminemic Elderly Cardiac Surgery Patients of Benefit with Regard to Inflammation, Endothelial Activation, and Long-Term Kidney Function? Anesth. Analg., November 1, 2008; 107(5): 1496 - 1503. [Abstract] [Full Text] [PDF]

				S. A. Kozek-Langenecker, C. Jungheinrich, W. Sauermann, and P. Van der Linden The Effects of Hydroxyethyl Starch 130/0.4 (6%) on Blood Loss and Use of Blood Products in Major Surgery: A Pooled Analysis of Randomized Clinical Trials Anesth. Analg., August 1, 2008; 107(2): 382 - 390. [Abstract] [Full Text] [PDF]

				J. Boldt, Ch. Brosch, K. Rohm, M. Papsdorf, and A. Mengistu Comparison of the effects of gelatin and a modern hydroxyethyl starch solution on renal function and inflammatory response in elderly cardiac surgery patients Br. J. Anaesth., April 1, 2008; 100(4): 457 - 464. [Abstract] [Full Text] [PDF]

				J. Boldt II. The balanced concept of fluid resuscitation Br. J. Anaesth., September 1, 2007; 99(3): 312 - 315. [Full Text] [PDF]

				G. H. Mills Hydroxyethyl starch: does our choice of colloid prevent or add to renal impairment? Br. J. Anaesth., February 1, 2007; 98(2): 157 - 159. [Full Text] [PDF]

				H. Knotzer, W. Pajk, S. Maier, M. W. Dunser, H. Ulmer, B. Schwarz, N. Salak, and W. R. Hasibeder Comparison of lactated Ringer's, gelatine and blood resuscitation on intestinal oxygen supply and mucosal tissue oxygen tension in haemorrhagic shock Br. J. Anaesth., October 1, 2006; 97(4): 509 - 516. [Abstract] [Full Text] [PDF]

				T. T. Niemi, R. T. Suojaranta-Ylinen, S. I. Kukkonen, and A. H. Kuitunen Gelatin and hydroxyethyl starch, but not albumin, impair hemostasis after cardiac surgery. Anesth. Analg., April 1, 2006; 102(4): 998 - 1006. [Abstract] [Full Text] [PDF]

				W. E. Johnston PRO: Fluid Restriction in Cardiac Patients for Noncardiac Surgery is Beneficial Anesth. Analg., February 1, 2006; 102(2): 340 - 343. [Full Text] [PDF]

				T. A. Neff, L. Fischler, M. Mark, R. Stocker, and W. H. Reinhart The Influence of Two Different Hydroxyethyl Starch Solutions (6% HES 130/0.4 and 200/0.5) on Blood Viscosity Anesth. Analg., June 1, 2005; 100(6): 1773 - 1780. [Abstract] [Full Text] [PDF]

				C. M. N. O'Malley, R. J. Frumento, M. A. Hardy, A. I. Benvenisty, T. E. Brentjens, J. S. Mercer, and E. Bennett-Guerrero A Randomized, Double-Blind Comparison of Lactated Ringer's Solution and 0.9% NaCl During Renal Transplantation Anesth. Analg., May 1, 2005; 100(5): 1518 - 1524. [Abstract] [Full Text] [PDF]

				K. P. Grichnik and T. A. D'Amico Acute Lung Injury and Acute Respiratory Distress Syndrome After Pulmonary Resection Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2004; 8(4): 317 - 334. [Abstract] [PDF]

				J. R. C. Braz, P. do Nascimento Jr., O. P. Filho, L. G. Braz, L. A. Vane, P. T. G. Vianna, and G. R. Rodrigues Jr. The Early Systemic and Gastrointestinal Oxygenation Effects of Hemorrhagic Shock Resuscitation with Hypertonic Saline and Hypertonic Saline 6% Dextran-70: A Comparative Study in Dogs Anesth. Analg., August 1, 2004; 99(2): 536 - 546. [Abstract] [Full Text] [PDF]

				J. Ragheb and D. J. Buggy Editorial III: Tissue oxygen tension (PTO2) in anaesthesia and perioperative medicine Br. J. Anaesth., April 1, 2004; 92(4): 464 - 468. [Full Text] [PDF]

				J. Boldt New Light on Intravascular Volume Replacement Regimens: What Did We Learn from the Past Three Years? Anesth. Analg., December 1, 2003; 97(6): 1595 - 1604. [Abstract] [Full Text] [PDF]

				T. A. Neff, M. Doelberg, C. Jungheinrich, A. Sauerland, D. R. Spahn, and R. Stocker Repetitive Large-Dose Infusion of the Novel Hydroxyethyl Starch 130/0.4 in Patients with Severe Head Injury Anesth. Analg., May 1, 2003; 96(5): 1453 - 1459. [Abstract] [Full Text] [PDF]

				T. Standl, M.-A. Burmeister, F. Schroeder, E. Currlin, J. Schulte am Esch, M. Freitag, and J. Schulte am Esch Hydroxyethyl Starch (HES) 130/0.4 Provides Larger and Faster Increases in Tissue Oxygen Tension in Comparison with Prehemodilution Values than HES 70/0.5 or HES 200/0.5 in Volunteers Undergoing Acute Normovolemic Hemodilution Anesth. Analg., April 1, 2003; 96(4): 936 - 943. [Abstract] [Full Text] [PDF]

				K. Holte, N. E. Sharrock, and H. Kehlet Pathophysiology and clinical implications of perioperative fluid excess Br. J. Anaesth., October 1, 2002; 89(4): 622 - 632. [Abstract] [Full Text] [PDF]

				C. Jungheinrich, R. Scharpf, M. Wargenau, F. Bepperling, and J.-F. Baron The Pharmacokinetics and Tolerability of an Intravenous Infusion of the New Hydroxyethyl Starch 130/0.4 (6%, 500 mL) in Mild-to-Severe Renal Impairment Anesth. Analg., September 1, 2002; 95(3): 544 - 551. [Abstract] [Full Text] [PDF]