[A comparative study of the effectiveness of 5% human albumin and 10% hydroxyethyl starch (HAES-steril) for correcting hemodynamics and O2 transport in surgical interventions]. / Sravnitel'noe issledovanie éffektivnosti primeneniia pri khirurgicheskikh vmeshatel'stvakh 5% chelovecheskogo al'bumina i 10% gidroksiétil-krakhmala (HAES-steril) po pokazateliam gemodinamiki i transporta O2.

Forty patients subjected to cavitary operations were examined. A high risk of hemodynamic disorders necessitated invasive monitoring; with this aim in view a catheter was inserted for measuring arterial pressure and the Swan-Ganz catheter for measuring the pressure in the pulmonary artery, in which helped monitor the hemodynamics and oxygen transport in the course of hypervolemic hemodilution. Plasma substitutes (one of two) were selected at random. After catheterization of the left radial artery and insertion of the Swan-Ganz catheter in the pulmonary artery through the internal right jugular vein the patients were infused either 5% human albumin or 10% hydroxyethyl starch in a dose of 125 ml every 5 min. The parameters of hemodynamics and oxygen transport were recorded after 500 ml of the solution was infused and the wedge pressure of 18 mm Hg attained. Both agents appreciably improved the mean arterial pressure, central nervous pressure, and wedge pressure. Cardiac index, left ventricular output, and stroke volume increased in both groups, and the pulmonary vascular resistance decreased. Both agents improved oxygen utilization and appreciably decreased hemoglobin level. The positive effect of hydroxyethyl starch on cardiac index, pulmonary vascular resistance, left ventricular output, and oxygen utilization was more expressed; moreover, a lesser dose of this drug was needed than of 5% human albumin (Behringwerke, Marburg, Germany). Loss of plasma caused by surgical intervention was better compensated for with synthetic colloid solutions, such as 10% HAES-steril (Fresinium, Oberurzel, Germany), provided that plasma protein level was at least 3-4 g/dl. The effect of 10% HAES-steril as regards the increase of circulating blood volume is 145%. Due to the hyperoncotic direction of its action it has a positive impact on the hemodynamics and oxygen transport and is needed in lower doses than other colloid solutions.

[Comparative study of the intraoperative effectiveness of 5% human albumin or 10% hydroxyethyl starch (HAES-steril) on hemodynamics and oxygen transport in 40 patients]. / Vergleichende Untersuchung zur intraoperativen Wirksamkeit von 5% Humanalbumin oder 10% Hydroxyäthylstärke (HAES-steril) auf Hämodynamik und Sauerstofftransport bei 40 Patienten.

In 40 patients, whose expected hemodynamic instability during surgery necessitated invasive monitoring (Swan-Ganz catheter) and arterial pressure monitoring the hemodynamic and oxygen transport parameters in conditions of hypervolemic hemodilution were investigated in randomized tests. After insertion of an arterial catheter (arteria radialis) as well as Swan-Ganz pulmonary arterial catheter via the vena jugularis interna, one of the two volume substitutes selected at random was infused in quantities of 125 ml/5 min and the hemodynamic changes were measured after infusion of 500 ml and finally after a wedge pressure of 18 mmHg was reached. Using either solution, the measurements indicated significant increases in mean arterial pressure as well as in central venous pressure (ZVD) and wedge pressure. The cardiac index, left ventricular stroke work index, and stroke output rose consecutively and pulmonary vascular resistance went down in both test groups. In the case of both volume substitutes, there was an improvement in oxygen availability. The hemoglobin content decreased in both groups, though to different degrees in each group. Although the hydroxyethyl starch group registered a greater improvement in the cardiac index, a bigger decrease in pulmonary vascular resistance, a higher rise in the left ventricular stroke work index and a more significant improvement in stroke output, smaller quantities of the volume substitute were required in this group than in the group in which volume substitution was carried out with human albumin 5%.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of hydroxyethyl starch and lactated Ringer's solution on hemodynamics and oxygen transport of critically ill patients in prospective crossover studies.

The cardiopulmonary effects of lactated Ringer's solution (RL) were compared with those of 10% hydroxyethyl starch, hetastarch (HES), given in 44 therapeutic interventions in 15 critically ill patients by crossover design. Each agent was given to each patient at least once; seven patients received each agent twice. Infusions were continued until the wedge pressure (WP) had increased to 16 +/- 2 mm Hg in trauma patients and 18 +/- 2.mm Hg in cardiac patients. HES 10% produced significantly increased cardiac index, left and right ventricular stroke work index, CVP, WP, oxygen delivery, oxygen consumption, and reduced pulmonary vascular resistance index (PVRI). RL increased CVP, WP, and PVRI, but did not significantly improve other hemodynamic or oxygen transport variables.

[Effect of colloid volume replacement substances and Ringer's lactate on hemodynamics and oxygen consumption of intensive care patients]. / Die Wirkung von kolloidalen Volumenersatzmitteln und Ringer-Laktat auf Hämodynamik und Sauerstoffverbrauch von Intensivpatienten.

Comparison of the effects of various volume substitutes on hemodynamics and oxygen transport variables in critically ill patients. A computerized monitoring system was used to register the hemodynamic effects of lactated ringers solution, human albumin 5%, human albumin 20%, hydroxyethylstarch 6% (Plasmasteril, Fresenius, Oberursel) and hydroxyethylstarch 10% (HAES-Steril, Fresenius, Oberursel) in 25 patients who required invasive monitoring during ICU treatment. In periods of relative volume deficits as documented by a wedge pressure of 11-13 mm of mercury the various substitutes were administered until the wedge pressure reached 15-17 mm of mercury. Comparison of 221 therapeutic interventions demonstrate: Hemydynamic and oxygen transport variables were improved in all colloid trials whereas lactated ringers solution did not improve the patients cardiopulmonary condition. In contrary pulmonary vascular resistance was significantly increased when Ringer's solution was administered. While all colloids produced improvements in the patients hemodynamic and oxygen transport condition, statistically significant improvements could be demonstrated only during infusion of hes 10%.

Evaluation of prognostic indices based on hemodynamic and oxygen transport variables in shock patients with adult respiratory distress syndrome.

We tested prospectively 30 hypotensive shock patients using a continuous, on-line, real-time hemodynamic and oxygen transport monitoring system with a previously described predictive index, modified for the clinical conditions in our ICU. Continuous monitoring and display of cardiac output and 20 or more derived variables, together with the predictive index, were a feasible and useful approach. Unlike previously documented series of elective postoperative general surgical patients, our series consisted of patients with multiple trauma, myocardial infarction, sepsis, and other medical emergencies as well as postoperative cardiac and general surgical patients, all of whom had respiratory failure (acute respiratory distress syndrome). In addition to these differences, our patients were invariably admitted to the ICU after the nadir of their hypotensive crisis. To compare the continuous recorded values with previous studies that used intermittent measurements, three comparable time intervals were selected; data at these time intervals and the predictions derived from them were in satisfactory agreement with prior studies. Moreover, therapeutic goals based on the median values of survivors of the present series were similar, but not identical, to prior series despite differences in the clinical mix and the later postresuscitation ICU admissions of our series.

[Reactions of critically ill patients to volume therapy with hydroxyethyl starch (6% HES 450/0.7)]. / Die Reaktionen kritisch kranker Patienten unter Volumentherapie mit hydroxyäthylstärke (6% HES 450/0,7).

At 31 critically ill surgical patients who on clinical grounds required fluid therapy, hemodynamic and oxygen transport, responses were measured after volume expansion with 500 ml 6% HES 450/0,7. There were statistically significant increases in cardiac index (CI) from 3,5 +/- 2,1 to maximal values of 4,4 +/- 0,2 (l/min/m2) and in wedge pressure (WP) from 9,3 +/- 0,7 to maximal values of 13,6 +/- 0,8 (mm Hg) and a significant reduction of systemic vascular resistance index (SVRI) from 2018 +/- 128 to 1641 +/- 102 (dynsec/cm5 m2). There were also observed statistically significant maximal increases of left ventricular stroke work index (LVSWI) from 41 +/- 3,1 to 53 +/- 3,2 (gm/m2) of oxygen delivery (DO2) from 489 +/- 24 to 587 +/- 29 (ml/min/m2) and of oxygen consumption (VO2) from 111 +/- 6 to 130 +/- 7 (ml/min/m2) which took place at the time of the maximum CI-increase. Moreover MAP-, CI- and VO2-responses of patients were stratified according to clinical conditions like time of operation, age, prognosis, ARDS, sepsis, hyperdynamic- and blood volume status.

Continuous, on-line, real-time measurement of cardiac output and derived cardiorespiratory variables in the critically ill.

A previously reported monitoring system provided continuous direct measurements of oxygen consumption and intravascular pressures. These data were combined with interval measurements of cardiac output and blood oxygen saturations to derive various hemodynamic and oxygen transport variables. This system has now been modified so that cardiac output is measured continuously in real-time.

Microcomputer-assisted monitoring system for measuring and processing cardiorespiratory variables: preliminary results of clinical trials.

A microcomputer-assisted monitoring system was developed for the continuous measuring and processing of cardiorespiratory variables, including: systemic and pulmonary arterial pressures, CVP, minute ventilation, inspired and expired O2 and CO2 concentrations, temperature, and heart rate. The primary data were converted to digital form, processed, displayed on a CRT monitor, and also stored for later evaluation. This system automatically calculated and displayed on-line and in real-time both primary measurements and derived cardiorespiratory variables, including: oxygen consumption, CO2 production, left and right ventricular stroke work, pulmonary venous admixture, and systemic and pulmonary vascular resistances. Printouts of the variables and trend graphs could be obtained for any desired time period. During its development, we tested this monitoring system in 30 critically ill patients, finding that the real-time calculation of cardiorespiratory variables was a great advantage during monitoring and treatment.

[Mathematical decription of the human intravascular elimination of HAS after repeated infusions]. / Die mathematische Beschreibung der intravasalen Ausscheidung von HAS nach wiederholten Infusionen beim Menschen.

Serum concentrations of high molecular weight-hydroxyethyl starch (HMW-HES, Mw 450,000 d, Mn 71,000 d, Mw/Mn = 6.3, MS = 0.7) were determined in normovolemic subjects dosed with three consecutive daily 500 ml infusions, to mathematically calculate the influence of the two-variable (Mw and MS) HES drug design system, on elimination of this material from the intravascular space under controlled conditions. Following the initial 500 ml (6% solution) infusion, the intravascular clearance up to 24-hours post-injection, was well predicted by the exponential equation: y = 3.94 + 3.34e-0.15x. On days two and three, the clearances up to 24-hours post-injection, were described by the equations: y = 6.32 + 3.75e-0.15x and y = 9.39 + 5.41e-0.15x, respectively. From these mathematical models, it appears that up to 24-hours post-injection on each of the three infusion days, HMW-HES is cleared from the bloodstream in a similar manner. HMW-HES clearance from the blood on day three, however, exhibited a slightly faster rate of decline, as seen by the larger coefficient attributed to the exponential component. The serum concentration of HMW-HES, 480 hours (2.9 weeks) following the third and final infusion, was 2.3 +/- 0.3 (SD) mg ml-1. Thus, in the 480-hour interval following the third and final injection, the serum concentration of HMW-HES measured at 10 minutes after injection 3, had been reduced by 85%. This decline in serum concentration following the infusion of HMW-HES, appears to be greater than previously reported by other investigators.

[Retrospective consideration of the incidence of anaphylactoid reactions following administration of Plasmasteril and Longasteril]. / Retrospektive Betrachtung der Häufigkeit anaphylaktoider Reaktionen nach Plasmasteril und Longasteril.

The frequency of anaphylacotid reactions following the infusion of colloidal volume substitutes has become more transparent in the recent years due to retrospective reports of several hospitals and especially by a prospective multi-clinical study carried out in the Bavarian area. As a contribution towards medicament safety by the manufacturers of infusion solutions, a quantitation of the incidents should be tried. For the period January 1974-June 1977 Dr. E. Fresenius KG has compared the units sold of HES (Plasmasteril) and Dextran 75 (Longasteril 75) with the reported incidents. The frequency of severe anaphylactoid reactions (type III + IV) amounted to 19/458 924 = 0.0041% for Dextran 75 and to 2/550 350 = 0.0004% for hydroxyethyl starch. The frequency of life-threatening incidents with HES proved to be lower than for Dextran 75 by the factor 10.