The choice of the intravenous fluid influences the tolerance of acute normovolemic anemia in anesthetized domestic pigsReportar como inadecuado




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Critical Care

, 16:R69

First Online: 30 April 2012Received: 23 December 2011Revised: 02 March 2012Accepted: 30 April 2012

Abstract

IntroductionThe 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.

MethodsThirty-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.

ResultsIn 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, and O2 extraction ratio was increased, when animals of the TS-, GEL- and HS-groups met their individual Hbcrit.

ConclusionsThe choice of the intravenous 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.

AbbreviationsANOVAanalysis of variance

BEbase excess

BSAbody surface area

BVIcirculating blood volume indexed to BSA

CaO2arterial oxygen content

CIcardiac index cardiac output indexed to BSA

DO2oxygen delivery

EVLWIextravascular lung water indexed to BSA

Hbcritcritical hemoglobin concentration

HEShydroxyethyl starch

HRheart rate

IVintravenous

ICGindocyaningreen

ITBVIintrathoracic blood volume indexed to BSA

MAPmean arterial pressure

MPAPmean pulmonary arterial pressure

O2-ERoxygen extraction ratio

paO2arterial oxygen partial pressure

PCWPpulmonary capillary wedge pressure

pvO2mixed-venous oxygen partial pressure

SVIstroke volume indexed to BSA

SVRIsystemic vascular resistance indexed to BSA

SVVstroke volume variation

VO2total body oxygen consumption.

Electronic supplementary materialThe online version of this article doi:10.1186-cc11324 contains supplementary material, which is available to authorized users.

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Autor: Andreas Pape - Saskia Kutschker - Harry Kertscho - Peter Stein - Oliver Horn - Mischa Lossen - Bernhard Zwissler - Oliver 

Fuente: https://link.springer.com/



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