Newly Published
Critical Care Medicine  |   October 2019
Resuscitation with Hydroxyethyl Starch Maintains Hemodynamic Coherence in Ovine Hemorrhagic Shock
Author Notes
  • From the Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital of Muenster, Muenster, Germany (P.-H.A., M.H., T.K., L.S., Y.M., H.V.A., C.E.); the Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, University of Rome, La Sapienza, Rome, Italy (A.M.); the Department of Anesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine and Pain Therapy, Protestant Hospital of the Bethel Foundation, Bielefeld, Germany (S.R.); and the Department of Intensive Care, Erasmus MC University Hospital Rotterdam, Rotterdam, The Netherlands (C.I.).
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • P.-H.A. and M.H. contributed equally to this article.
    P.-H.A. and M.H. contributed equally to this article.×
  • Submitted for publication October 29, 2018. Accepted for publication August 27, 2019.
    Submitted for publication October 29, 2018. Accepted for publication August 27, 2019.×
  • Correspondence: Address correspondence to Dr. Arnemann: Department of Anesthesiology, Intensive Care and Pain Medicine, Albert-Schweitzer-Campus 1, Building A1, University Hospital of Muenster, 48149 Muenster, Germany. arnemann@anit.uni-muenster.de. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Critical Care Medicine / Cardiovascular Anesthesia / Coagulation and Transfusion / Critical Care
Critical Care Medicine   |   October 2019
Resuscitation with Hydroxyethyl Starch Maintains Hemodynamic Coherence in Ovine Hemorrhagic Shock
Anesthesiology Newly Published on October 17, 2019. doi:https://doi.org/10.1097/ALN.0000000000002998
Anesthesiology Newly Published on October 17, 2019. doi:https://doi.org/10.1097/ALN.0000000000002998
Abstract

Editor’s Perspective:

What We Already Know about This Topic:

  • Both saline and hydroxyethyl starch can be used for fluid resuscitation of hemorrhagic shock

  • Hemodynamic coherence is the concordant performance of macro- and microcirculation

  • It is not known whether saline or hydroxyethyl starch resuscitation achieves better hemodynamic coherence

What This Article Tells Us That Is New:

  • In a sheep model of hemorrhagic shock, resuscitation with both saline and hydroxyethyl starch restored mean arterial pressure (macrocirculation)

  • After fluid resuscitation with hydroxyethyl starch, microcirculatory perfused vessel density and microvascular flow index (microcirculation) both improved, whereas saline only marginally improved microvascular flow index and perfused vessel density decreased further

  • Resuscitation with hydroxyethyl starch but not saline maintained hemodynamic coherence after hemorrhagic shock

Background: Fluid resuscitation in hemorrhagic shock aims to restore hemodynamics and repair altered microcirculation. Hemodynamic coherence is the concordant performance of macro- and microcirculation. The present study on fluid therapy in hemorrhagic shock hypothesized that the choice of fluid (0.9% sodium chloride [saline group] or balanced 6% hydroxyethyl starch 130/0.4 [hydroxyethyl starch group]) impacts on hemodynamic coherence.

Methods: After instrumentation, 10 sheep were bled up to 30 ml/kg body weight of blood stopping at a mean arterial pressure of 30 mmHg to establish hemorrhagic shock. To reestablish baseline mean arterial pressure, they received either saline or hydroxyethyl starch (each n = 5). Hemodynamic coherence was assessed by comparison of changes in mean arterial pressure and both perfused vessel density and microvascular flow index.

Results: Bleeding of 23 ml/kg blood [21; 30] (median [25th; 75th percentile]) in the saline group and 24 ml/kg [22; 25] (P = 0.916) in the hydroxyethyl starch group led to hemorrhagic shock. Fluid resuscitation reestablished baseline mean arterial pressure in all sheep of the hydroxyethyl starch group and in one sheep of the saline group. In the saline group 4,980 ml [3,312; 5,700] and in the hydroxyethyl starch group 610 ml [489; 615] of fluid were needed (P = 0.009). In hemorrhagic shock perfused vessel density (saline from 100% to 83% [49; 86]; hydroxyethyl starch from 100% to 74% [61; 80]) and microvascular flow index (saline from 3.1 [2.5; 3.3] to 2.0 [1.6; 2.3]; hydroxyethyl starch from 2.9 [2.9; 3.1] to 2.5 [2.3; 2.7]) decreased in both groups. After resuscitation both variables improved in the hydroxyethyl starch group (perfused vessel density: 125% [120; 147]; microvascular flow index: 3.4 [3.2; 3.5]), whereas in the saline group perfused vessel density further decreased (64% [62; 79]) and microvascular flow index increased less than in the hydroxyethyl starch group (2.7 [2.4; 2.8]; both P < 0.001 for saline vs. hydroxyethyl starch).

Conclusions: Resuscitation with hydroxyethyl starch maintained coherence in hemorrhagic shock. In contrast, saline only improved macro- but not microcirculation. Hemodynamic coherence might be influenced by the choice of resuscitation fluid.