Skip to main content
SpringerLink
Log in

Low molecular weight hydroxyethyl starch 6% compared to albumin 4% during intentional hemodilution

  • Originals
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Intentional normovolemic hemodilution was chosen as the model to compare a 6% low molecular weight hydroxyethyl starch (LMW HES) to 4% albumin. The study ran over the plasma exchange period for 24 h. Nine patients, scheduled for abdominal aortic surgery, were included in each group. After basal measurements, blood was withdrawn and simultaneously replaced by either 4% albumin (Group 1) or 6% LMW HES (Group 2) to achieve a final hematocrit of approximately 30%. Hemodynamic blood oxygen gas and hormonal plasma levels were determined before hemodilution then at 30 min, 1, 2, 3, and 24 h after the end of hemodilution. Basal value for total blood volume was 4377±162 ml in group 1 and 4138±315 ml in group 2. As in both groups the decrease in blood cell volume was exactly compensated by the increase in plasma volume, no significant change in total blood volume (respectively 4432±159 and 4305±267 ml) was observed. Throughout the study, in both groups, no significant change in mean arterial and right atrial pressures was observed. In group 2 (LMW HES), a significant increase of pulmonary capillary wedge pressure was noted 120 min after hemodilution. After hemodilution, despite a significant decrease in arterial oxygen O2 content, systemic oxygen transport did not significantly vary until 24 h in relation to the increased cardiac index. An increase in O2 extraction was observed until the 24 h. No significant chagnes either in global O2 consumption or in lactate concentration were detected. Plasma renin activity fell in both groups while atrial natriuretic factor increased with a peak value at the 2 h. These data suggest that LMW HES as well as 4% albumin was able to maintain at least normovolemia during a 24 h period after intentional hemodilution.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Thompson WL (1980) Hydroxyethyl starch. Dev Biol Stand 44:259–266

    Google Scholar 

  2. Rackow EC, Falk JL, Fein A, Siegel JS, Packman MI, Haupt MT, Kaufman BS, Putnam D (1983) Fluid resuscitation in circulatory shock: a comparison of the cardiorespiratory effects of albumin, hetastarch, and saline solutions in patients with hypovolemic and septic shock. Crit Care Med 11:839–851

    Google Scholar 

  3. Kirklin JK, Lell WA, Kouchoukos NT (1984) Hydroxyethyl starch vs albumin for colloid infusion following cardiopulmonary bypass in patients undergoing myocardial revascularization. Ann Thorac Surg 37:40–46

    Google Scholar 

  4. Moggio RA, Rha CC, Somberg ED, Praeger PI, Pooley RW, Reed GE (1983) Hemodynamic comparison of albumin and hydroxyethyl starch in postoperative cardiac surgery patients. Crit Care Med 11:943–945

    Google Scholar 

  5. Diehl JT, Lester JL, Cosgrove DM (1982) Clinical comparison of hetastarch and albumin in postoperative cardiac patients. Ann Thorac Surg 34:674–679

    Google Scholar 

  6. Porter SS, Goldberg RJ (1986) Intraoperative allergic reactions to hydroxyethyl starch: a report of 2 cases. Can Anaesth Soc J 33:394–398

    Google Scholar 

  7. Lockwood DNJ, Bullen C, Machin SJ (1988) A severe coaguloathy following volume replacement with hydroxyethyl starch in a Jehovah's witness. Anaesthesia 43:391–393

    Google Scholar 

  8. Sanfelippo MJ, Suberviiola PD, Geimer NF (1987) Development of a von Willebrand-like syndrome after prolonged use of hydroxyethyl starch. Am J Clin Pathol 88:653–655

    Google Scholar 

  9. Bogan RK, Gale GR, Walton RP (1969) Fate of 14C-labeled hydroxyethyl starch in animals. Toxicol Appl Pharmacol 15:206–211

    Google Scholar 

  10. Dienes HP, Gerharz CD, Wagner R, Weber M, John HD (1986) Accumulation of hydroxyethyl starch in the liver of patients with renal failure and portal hypertension. J Hepatol 3:223–227

    Google Scholar 

  11. Strauss RG, Stanfield C, Heriksen RA, Villhauer PJ (1988) Pentastarch may cause fewer effects on coagulation than hetastarch. Transfusion 28:257–260

    Google Scholar 

  12. Peuler JD, Johnson GA (1977) Simultaneous single isotope radioenzymatic assay of plasma norepinephrine, epinephrine and dopamine. Life Sci 21:625–636

    Google Scholar 

  13. Fievet P, Pleskov L, Desailly I, Carayon A, De Fremont JF, Coevet B, Comoy E, Demory JE, Verhoest P, Boulanger JC, Fournier A (1983) Plasma renin activity, blood uric acid and plasma volume in pregnancy induced hypertension. Proc Eur Dial Transplant Assoc 20:520–529

    Google Scholar 

  14. Carman FS, Dreiling CE, Brown DE (1988) Prepagation of serum oxytocin and arginine vasopressin prior to radioimmunoassay: simultaneous extraction and separation of C 18 Sep-Pak cartridges. Clin Biochem 21:265–269

    Google Scholar 

  15. Deray G, Maistre G, Cacoub P, Carayon A, Leger P, Rottembourg J, Anouan M, Sassano P, Cabrol C (1988) Plasma concentrations of atrial natriuretic peptide in patients with artificial and transplanted hearts. Eur J Clin Pharmacol 34:91–93

    Google Scholar 

  16. Shoemaker WC (1962) Measurement of rapidly and slowly circulating red cell volumes in hemorrhagic shock. Am J Physiol 202:1179–1183

    Google Scholar 

  17. Puri VK, Paidipaty B, White L (1981) Hydroxyethyl starch for resuscitation of patients with hypovolemia and shock. Crit Care Med 9:833–837

    Google Scholar 

  18. Saunders CR, Carlisle L, Bick KL (1983) Hydroxyethyl starch versus albumin in cardiopulmonary bypass prime solutions. Ann Thorac Surg 36:532–539

    Google Scholar 

  19. Shatney CH, Deepika K, Militello PR, Majerus TC, Dawson RB (1983) Efficacy of hetastarch in the resuscitation of patients with multisystem trauma and shock. Arch Surg 118:804–809

    Google Scholar 

  20. Palanzo DA, Parr GVS, Bull AP, Williams DR, O'Neill MJ, Waldhausen JA (1982) Hetastarch as a prime for cardiopulmonary bypass. Ann Thorac Surg 34:681–683

    Google Scholar 

  21. Hankeln K, Rödel C, Beez M, Laniewski P, Bohmert F (1989) Comparison of hydroxyethyl starch and lactated ringer's solution on hemodynamics and oxygen transport of critically ill patients in prostective crossover studies. Crit Care Med 17:133–135

    Google Scholar 

  22. Waxmann K, Holness R, Tominaga G, Chela P, Grimes J (1989) Hemodynamic and oxygen transport effects of pentastarch in burn resuscitation. Ann Surg 209:341–345

    Google Scholar 

  23. Rackow EC, Mecher C, Astiz ME, Griffel M, Falk JL, Weil MH (1989) Effects of pentastarch and albumin infusion on cardiorespiratory function and coagulation in patients with severe sepsis and systemic hypoperfusion. Crit Care Med 17:394–398

    Google Scholar 

  24. London MJ, Ho JS, Triedmann JK, Verrier ED, Levin J, Merrick SH, Hanley FL, Browner WS, Mangano DT (1989) A randomized clinical trial of 10% pentastarch (low molecular weight hydroxethyl starch) versus 5% albumin for plasma volume expansion after cardiac operations. J Thorac Cardiovasc Surg 97:785–797

    Google Scholar 

  25. Hankeln K, Lenz I, Hauser B (1988) Hämodynamische Effekte von 6% Hydroxyathylstärke (H.A.E.S. 200 000/0,62). Anaesthesist 37:167–172

    Google Scholar 

  26. Iguchi K, Ikeda K (1971) Clinical investigations of a new plasma expander partially substituted HES. Med Consul N Remed 8:139–150

    Google Scholar 

  27. Ikejiri T, Nomiyama T, Yamaguchi K, Ushijima K, Hirata K (1971) Influence on renal function and blood pressure maintenance effect during operations of HES plasma expander. Med Consul N Remed 8:2501–2514

    Google Scholar 

  28. Konishi Y, Konishi T, Nagasaki A (1971) Clinical experience of a new plasma expander, partially substituted, HES. Med Consul N Remed 8:2525–2531

    Google Scholar 

  29. Odeki K, Kakuta S, Watanabe K, Imal T, Yoshitake K (1971) Investigation in surgical clinis of HES. J N Remed Clin 20:1939–1947

    Google Scholar 

  30. Bringuier J, Ozier Y, Quere JF, Bernard D, Rebiere D, Conseiller C (1990) Expansion volémique avec l'albumine à 4%. Ann Fr Anesth Réanim 9 [Suppl]:R 141

    Google Scholar 

  31. Lazrove S, Waxman K, Shippy C, Shoemaker WC (1980) Hemodynamics, blood volume and oxygen transport responses to albumin and hydroxyethyl starch infusions in critically ill postoperative patients Crit Care Med 8:302–306

    Google Scholar 

  32. Shoemaker WC (1976) Comparison of the relative effectiveness of whole blood transfusions and various types of fluid therapy in resuscitation. Crit Care Med 4:71–79

    Google Scholar 

  33. Schartzkopff W, Schartzkopff B, Wurm W, Frisius H (1981) Physiological aspects of the role of human albumin in the treatment of chronic and acute blood loss. Dev Biol Stand 48:7–30

    Google Scholar 

  34. Laks H, Pilon R, Klovekorn WP, Anderson W, McCallum J, O'Connors NE (1974) Acute hemodilution: its effects on hemodynamics and oxygen transport in anesthetized man. Ann Surg 180:103–109

    Google Scholar 

  35. Shah DM, Prichard MN, Newell JC, Karmody AM, Scovill WA, Powers SR (1980) Increased cardiac output and oxygen transport after intraoperative isovolemic hemodilution. A study in patients with peripheral vascular desease. Arch Surg 115:597–600

    Google Scholar 

  36. Glick G, Plauth WH, Braunwald E (1964) Role of autonomic nervous system in the circulatory response to acute induced anemia in unanesthetized dogs. J Clin Invest 43:2112–2124

    Google Scholar 

  37. Billman GE, Dickey DT, Teoh KK, Stone HL (1981) Effects of central venous return shifts on arterial baroreflex control of heart rate. Am J Physiol 241:H571-H575

    Google Scholar 

  38. Ferber HP, Nitsch E, Forster H (1985) Studies on hydroxyethyl starch: changes of the molecular weight distribution for hydroxyethyl starch types 450/0.7, 450/0.5, 450/0.3, 300/0.4, 200/0.7, 200/0.5, 200/0.3, 200/0.1 after infusion in serum and urine of volonteers. Arzneimittelforsch/Drug Res 35:615–622

    Google Scholar 

  39. Vicaut E, Strucker O, Teisseire B, Duvelleroy M (1987) Effects of changes in systemic hematocrit on the microcirculation in rat cremaster muscle. Int J Microcirc Clin Exp 6:225–235

    Google Scholar 

  40. Espinier EA, Crozier IG, Nicholls MG, Cuneo R, Yandle TG, Ikram H (1985) Cardiac secretion of atrial natriuretic peptide. Lancet 198–399

  41. Mancini GBJ, McGillem MJ, Bates ER, Weder AB, Doboe SF, Grekin RJ (1987) Hormonal responses to cardiac tamponade: inhibition of release of atrial natriuretic factor despite elevation of atrial pressures. Circulation 76:844–890

    Google Scholar 

  42. Mitchell KD, Navar LG (1989) The renin-angiotensin-aldosterone system in volume control. Baillère's Clin Endocrinol Metab 3:393–429

    Google Scholar 

  43. Kurtz A, Bruna RD, Pfeilschifter J, Taugner R, Bauer C (1986) Atrial natriuretic peptide inhibits renin release from juxtaglomerular cells by a cGMP-mediated process. Proc Natl Acad Sci 83:4769–4773

    Google Scholar 

  44. Pruszczynski W, Viron B, Mignon F, Ardaillou R (1987) Massive plasma vasopressin (AVP) removal during hemofiltration stimulates AVP secretion in humans. J. Clin Endocrinol Metab 64:383–386

    Google Scholar 

  45. Norsk P (1989) Influence of low and high pressure baroreflexes on vasopressine release in humans. Acta Endocrinol 121:1–27

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Hôpital Pitié-Salpétrière, Paris, France

    J. -F. Baron, D. De Kegel, A. C. Prost, O. Mundler, M. Arthaud, G. Basset, G. Maistre, F. Masson, A. Carayon, C. Landault, E. Barré & P. Viars

  2. Département d'Anesthésie-Réanimation, Hôpital Pitié-Salpétrière, 47 Boulevard de l'Hôpital, F-75013, Paris, France

    J. -F. Baron

Authors
  1. J. -F. Baron
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. De Kegel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. C. Prost
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. O. Mundler
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Arthaud
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G. Basset
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. G. Maistre
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. F. Masson
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. A. Carayon
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. C. Landault
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. E. Barré
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. P. Viars
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Baron, J.F., De Kegel, D., Prost, A.C. et al. Low molecular weight hydroxyethyl starch 6% compared to albumin 4% during intentional hemodilution. Intensive Care Med 17, 141–148 (1991). https://doi.org/10.1007/BF01704717

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01704717

Key words

Search

Navigation