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Comparison of 6% hydroxyethyl starch 130/0.4 and saline solution for resuscitation of the microcirculation during the early goal-directed therapy of septic patients

Servicio de Terapia Intensiva, Sanatorio Otamendi y Miroli, Azcuénaga 870, Buenos Aires C1115AAB, Argentina.
Journal of critical care (Impact Factor: 2.19). 12/2010; 25(4):659.e1-8. DOI: 10.1016/j.jcrc.2010.04.007
Source: PubMed

ABSTRACT The aim of this study was to show that 6% hydroxyethyl starch (HES) 130/0.4 achieves a better resuscitation of the microcirculation than normal saline solution (SS), during early goal-directed therapy (EGDT) in septic patients.
Patients with severe sepsis were randomized for EGDT with 6% HES 130/0.4 (n = 9) or SS (n = 11). Sublingual microcirculation was evaluated by sidestream dark field imaging 24 hours after the beginning of EGDT.
On admission, there were no differences in Sequential Organ Failure Assessment score, mean arterial pressure, lactate, or central venous oxygen saturation. After 24 hours, no difference arose in those parameters. Sublingual capillary density was similar in both groups (21 ± 8 versus 20 ± 3 vessels/mm(2)); but capillary microvascular flow index, percent of perfused capillaries, and perfused capillary density were higher in 6% HES 130/0.4 (2.5 ± 0.5 versus 1.6 ± 0.7, 84 ± 15 versus 53 ± 26%, and 19 ± 6 versus 11 ± 5 vessels/mm(2), respectively, P < .005).
Fluid resuscitation with 6% HES 130/0.4 may have advantages over SS to improve sublingual microcirculation. A greater number of patients would be necessary to confirm these findings.

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    • "respectively). ICU mortality was lower in the starch group when analyzing only randomized controlled trials, however this result was due to the inclusion of the studies by Dubin et al [9], and Lv et al [13], that were both of low quality (RR, 0.42 [95% CI, 0.24- 0.73]) [13] [14] (Fig. E2). AKI was higher in the group of HES in all subgroup analyses with the exception in studies where the colloid infusion on the first day was less than 1500 mL (RR, 1.20 [95% CI, 0.98-1.47]). "
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    Journal of critical care 10/2013; 29(1). DOI:10.1016/j.jcrc.2013.09.031 · 2.19 Impact Factor
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    • "In healthy volunteers, PPVs (small vessels) well above 90% are described, whereas in septic patients, a capillary PPV of 78% (23%) is described [11] [42] [43]. In septic shock, norepinephrine dose >0.1 microgram/kg/min and a lactate >2 mmol/L were associated with a significantly lower PVD (12 [8] [9] [10] [11] [12] [13] [14] [15] versus 14 [11] [12] [13] [14] [15] [16] [17] n/mm 2 for norepinephrine dose >0.1 microgram/kg/min and 10 [8] [9] [10] [11] [12] [13] versus 14 [11] [12] [13] [14] [15] [16] [17] n/mm 2 for lactate >2 mmol/L), as well as a significantly lower PPV (80 [70–91] versus 100 [90] [91] [92] [93] [94] [95] [96] [97] [98] [99] [100]% for norepinephrine dose >0.1 microgram/kg/min and 82 [71–99] versus 93 [84–100]% for lactate >2 mmol/L) [44]. In uncomplicated major abdominal surgery, preoperative PPV (small vessels) was 89% (83–95) versus 79% (73–92) in patients who developed complications postoperatively [4]. "
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    • "Then Arnold et al. reported that a determination of MFI during bedside video acquisition (MFI point of care ) gave a good agreement with the MFI by quadrants [12]. Finally, Dubin et al. used the mean value of the MFI determined in each individual vessel (MFI vessel by vessel ) [1] [8] [9]. This analysis is time consuming but tightly correlated with the actual red blood cell (RBC) velocity measured with a software both in experimental and clinical conditions [1] [13] [14]. "
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    Critical care research and practice 04/2012; 2012:102483. DOI:10.1155/2012/102483
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