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Fluid resuscitation with colloids of different molecular weight in septic shock

Molnar, Z., Mikor, A., Leiner, T. and Szakmany, Tamas 2004. Fluid resuscitation with colloids of different molecular weight in septic shock. Intensive Care Medicine 30 (7) , pp. 1356-1360. 10.1186/cc2597

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Objective The aim of this study was to investigate the short-term effect of fluid resuscitation with 4% modified fluid gelatine (GEL) versus 6% hydroxyethyl starch (HES) on haemodynamics and oxygenation in patients with septic shock and acute lung injury (ALI). Design Prospective randomised clinical trial. Setting Twenty-bed intensive care unit in a university hospital. Patients Thirty hypovolemic patients (intrathoracic blood volume index, ITBVI <850 ml/m2) in septic shock with ALI were randomised into HES (mean molecular weight: 200,000 Dalton, degree of substitution 0.6) and GEL (mean molecular weight: 30,000 Dalton) groups (15 patients each). Interventions For fluid resuscitation 250 ml/15 min boluses (max. 1,000 ml) were given until the end point of ITBVI >900 ml/m2 was reached. Repeated haemodynamic measurements were done at baseline (tb), at the end point (tep) then at 30 min and 60 min after the end point was reached (t30, t60). Cardiac output, stroke volume, extravascular lung water (EVLW), and oxygen delivery was determined at each assessment point. For statistical analysis two-way ANOVA was used. Measurements and results ITBVI, cardiac index, and oxygen delivery index increased significantly at tep and remained elevated for t30 and t60, but there was no significant difference between the two groups. The increase in the ITBVI by 100 ml of infusion was similar in both groups (HES: 26±19 ml/m2 vs GEL: 30±19 ml/m2). EVLW, remained unchanged, and there was no significant difference between the groups (HES, tb: 8±6, t60: 8±6; GEL, tb: 8±3, t60: 8±3 ml/kg). The PaO2/FiO2 did not change significantly over time or between groups (HES, tb: 207±114, t60: 189±78; GEL, tb: 182±85, t60: 182±85 mmHg). Conclusion The results of this study indicate that both HES and GEL infusions caused similar short-term change in ITBVI in septic shock, without increasing EVLW or worsening oxygenation.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Subjects: R Medicine > RC Internal medicine
Uncontrolled Keywords: Septic shock – Acute lung injury – Fluid resuscitation – Colloid – Extravascular lung water
Publisher: Springer Verlag
ISSN: 0342-4642
Last Modified: 30 Jun 2017 02:46

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