Hemodynamic effects of 6% and 10% hydroxyethyl starch solutions versus 4% albumin solution in septic patients

• Published in: Journal of clinical anesthesia 2008-11, Vol.20 (7), p.528-533
• Main Authors: Friedman, Gilberto, MD, PhD, Jankowski, Stanislaw, FRCP, Shahla, Mohammad, MD, DDS, Gomez, Jussara, MD, Vincent, Jean-Louis, MD, PhD
• Format: Article
• Language: English
• Subjects: Aged; Anesthesia; Anesthesia & Perioperative Care; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Bacterial diseases; Bacterial sepsis; Biological and medical sciences; Cardiac index critical care; Dose-Response Relationship, Drug; Female; Hemodynamics; Hemodynamics - drug effects; Hemoglobin; Hemoglobins - analysis; Human bacterial diseases; Humans; Hydroxyethyl starch; Hydroxyethyl Starch Derivatives - administration & dosage; Hydroxyethyl Starch Derivatives - adverse effects; Hypovolemia; Infectious diseases; Intravenous fluids; Male; Medical sciences; Middle Aged; Oxygen Consumption - drug effects; Oxygen delivery; Pain Medicine; Plasma Substitutes - administration & dosage; Plasma Substitutes - adverse effects; Pulmonary arteries; Sepsis - physiopathology; Serum Albumin - administration & dosage; Serum Albumin - adverse effects; Stroke volume index; Time Factors; Treatment Outcome
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2008.05.022

Abstract Study Objective To compare the hemodynamic effects of two different concentrations of pentastarch hydroxyethyl starch (HES; 200/0.5) solutions with a 4% human albumin solution for fluid resuscitation. Design Open-label, randomized, controlled study. Setting Medical-surgical intensive care unit. Patients 34 consecutive, hemodynamically stable, adult patients with sepsis and suspected hypovolemia. Interventions Patients received a 400 mL infusion of either 10% HES (n = 11), 6% HES (n = 10), or 4% albumin (n = 13) over 40 minutes. Measurements Hemodynamic and blood data were collected 40, 70, 100, and 160 minutes after the start of the fluid challenge. Main Results Cardiac index, stroke volume index, and left ventricular stroke work index increased more in the 10% HES group than the 6% HES or albumin groups ( P < 0.05). Oxygen delivery increased only in the 10% HES group. A decrease in hemoglobin concentration occurred in all three groups but was greatest in the 10% HES group. Conclusions HES is as effective as albumin for volume resuscitation in septic patients.