Mechanisms of postoperative prolonged plasma volume expansion with low molecular weight hydroxethy starch (HES 200/0.62, 6%).
Intensive Care Med
; 21(7): 577-83, 1995 Jul.
Article
em En
| MEDLINE
| ID: mdl-7593900
ABSTRACT
OBJECTIVE:
To define the mechanisms of the stable and prolonged post-operative plasma volume expansion observed with Hydroxyethyl Starches (HES) and to determine whether a partial intravascular hydrolysis of large molecules contribute to reinforce the colloid-osmotic effect.DESIGN:
Prospective, pharmacologic study using single dose of drug.SETTING:
University-based, post-anesthesia care unit. PATIENTS The protocol was performed during the post-operative period, in 10 patients after stable recovery from general anesthesia for carotid endarterectomy.INTERVENTIONS:
HES 200/0.62 (500 ml) was infused over 30 min. Standard hemodynamic and biological variables, HES concentration and colloid osmotic pressure were obtained at each measurement. Plasma volume was calculated using 51Cr-labelled RBCs. Patterns of changes in number average molecular weight (MWn) and weight average MW (MWw) were measured using gel permeation chromatography. Measurements were obtained at control, end of infusion, 1 h, 3 h, 6 h and 24 h after infusion. MEASUREMENTS AND MAINRESULTS:
Plasma volume increased by 693 ml (+21%) after the infusion of HES and remained constant over 24 h. HES concentration progressively decreased to reach a value of 35% of the peak at 24 h. MWn and MWw, initially decreased when compared with the dose solution and changed little in the 24 h study period. Diuresis significantly decreased at 3 h up to 24 h. Plasma albumin decreased after infusion and then progressively increased to reach a significantly higher value at 24 h than after infusion.CONCLUSION:
Initial plasma volume expansion and decrease in HES concentration agree with previously-published data. Maintenance of plasma volume expansion over 24 h was not related to a partial intravascular hydrolysis. Low elimination rate of HES, extravascular mobilization of albumin and post-operative renal adaptations were possibly the 3 main mechanisms to explain a prolonged plasma volume expansion with HES 200/0.62, 6%.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Volume Plasmático
/
Polímeros
/
Amido
/
Substitutos do Plasma
Tipo de estudo:
Observational_studies
Limite:
Aged
/
Humans
/
Middle aged
Idioma:
En
Revista:
Intensive Care Med
Ano de publicação:
1995
Tipo de documento:
Article
País de afiliação:
França