British Journal of Anaesthesia, Vol 77, Issue 4 480-487, Copyright © 1996 by The Board of Management and Trustees of the British Journal of Anaesthesia
J. Boldt, M. Mueller, T. Menges, M. Papsdorf and G. Hempelmann
Various vasoactive substances are involved in the regulation of the macro-
and microcirculation. We have investigated if these regulators change
during long-term volume therapy with human albumin (HA) or
hydroxyethylstarch solution (HES) in trauma and sepsis patients. To
maintain pulmonary capillary wedge pressure (PCWP) at 10-15 mm Hg, either
20% HA (HA-trauma, n = 14; HA-sepsis, n = 14) or 10% low- molecular weight
HES solution (HES-trauma, n = 14; HES-sepsis, n = 14) were infused for 5
days, otherwise patient management did not differ between the two groups
(trauma/sepsis). Mean arterial pressure (MAP), heart rate (HR), PCWP and
cardiac index (CI) were monitored in all patients. Liver function was
assessed using the monoethylglycinexylidide (MEGX) test, and gastric
intramucosal pH (pHi) was monitored by tonometry to assess splanchnic
perfusion. Plasma concentrations of vasopressin, endothelin-1, adrenaline,
noradrenaline, atrial natriuretic peptide and 6-keto-prostaglandin F1 alpha
were measured from arterial blood samples. All measurements were carried
out on the day of admission to the intensive care unit (trauma patients) or
on diagnosis of sepsis, and daily over the next 5 days at 12:00. MAP, HR
and PCWP did not differ between the corresponding subgroups
(trauma/sepsis). Cl increased significantly more in the HES than in the HA
groups. pHi and MEGX plasma concentrations did not differ in the trauma
patients throughout the study. Both were lower than normal in the sepsis
groups and increased more markedly in the HES than in the albumin-treated
patients (P < 0.05). In the trauma patients, concentrations of all
vasoactive regulators were very similar in both groups. In both sepsis
groups, vasopressors (vasopressin, endothelin-1, noradrenaline and
adrenaline) were significantly increased above normal at baseline and
decreased more markedly in HES than in HA patients. Concentrations of
atrial natriuretic peptide increased only in the HA patients (from 159 (SD
31) to 215 (38) pg ml-1 on day 2). Plasma concentrations of
6-keto-prostaglandin F1 alpha decreased significantly only in the HES
sepsis patients (from 112 (25) to 47 (15) pg ml-1).
CLINICAL INVESTIGATIONS
Influence of different volume therapy regimens on regulators of the circulation in the critically ill
Department of Anaesthesiology and Intensive Care Medicine, Justus-Liebig-University Giessen, 35392 Giessen, Germany
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