The choice of the intravenous fluid influences the tolerance of acute normovolemic anemia in anesthetized domestic pigs

The correction of hypovolemia with acellular fluids results in acute normovolemic anemia. Whether the choice of the infusion fluid has an impact on the maintenance of oxygen (O2) supply during acute normovolemic anemia h
The correction of hypovolemia with acellular fluids results in acute normovolemic anemia. Whether the choice of the infusion fluid has an impact on the maintenance of oxygen (O2) supply during acute normovolemic anemia has not been investigated so far.
METHODS:

Thirty-six anesthetized and mechanically ventilated pigs were hemodiluted to their physiological limit of anemia tolerance, reflected by the individual critical hemoglobin concentration (Hbcrit). Hbcrit was defined as the Hb-concentration corresponding with the onset of supply-dependency of total body O2-consumption (VO2). The hemodilution protocol was randomly performed with either Tetrastarch (6% HES 130/0.4, TS-group, n=9), Gelatin (3.5% urea-crosslinked polygeline, GEL-group, n=9), Hetastarch (6% HES 450/0.7, HS-group, n=9) or Ringer's solution (RS-group, n=9). The primary endpoint was the dimension of Hbcrit, secondary endpoints were parameters of central hemodynamics, O2-transport and tissue oxygenation.
RESULTS:

In each animal, normovolemia was maintained throughout the protocol. Hbcrit was met at 3.7+/-0.6 g/dl (RS), 3.0+/-0.6 g/dl (HS P<0.05 vs. RS), 2.7+/-0.6 g/dl (GEL, P<0.05 vs. RS) and 2.1+/-0.4 g/dl (TS, P<0.05 vs. GEL, HS and RS). Hemodilution with RS resulted in a significant increase of extravascular lung water index (EVLWI) and a decrease of arterial oxygen partial pressure (paO2), O2-extraction ratio was increased, when animals of the TS-, GEL- and HS-groups met their individual Hbcrit.
CONCLUSIONS:

The choice of the intravenous (i.v) fluid has an impact on the tolerance of acute normovolemic anemia induced by acellular volume replacement. Third-generation Tetrastarch preparations (e.g., HES 130/0.4) appear most advantageous regarding maintenance of tissue oxygenation during progressive anemia. The underlying mechanism includes a lower degree of extravasation and favourable effects on microcirculatory function.
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Metadaten
Author:Andreas Pape, Saskia Kutschker, Harry Kertscho, Peter Stein, Oliver Horn, Mischa Lossen, Bernhard Zwissler, Oliver Habler
URN:urn:nbn:de:hebis:30:3-248371
DOI:http://dx.doi.org/doi:10.1186/cc11324
ISSN:1875-7081
ISSN:1574-4280
Pubmed Id:http://www.ncbi.nlm.nih.gov/pubmed?term=22546374
Parent Title (English):Critical care
Publisher:Bohn Stafleu Van Loghum
Place of publication:Houten
Document Type:Article
Language:English
Date of Publication (online):2012/04/30
Date of first Publication:2012/04/30
Publishing Institution:Univ.-Bibliothek Frankfurt am Main
Release Date:2012/05/22
Volume:16
Issue:R69
Pagenumber:11
First Page:1
Last Page:11
Institutes:Medizin
Dewey Decimal Classification:610 Medizin und Gesundheit
Sammlungen:Universitätspublikationen
Licence (German):License LogoCreative Commons - Namensnennung 3.0

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