+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Small volume hypertonic hydroxyethyl starch reduces acute microvascular dysfunction after closed soft-tissue trauma

Small volume hypertonic hydroxyethyl starch reduces acute microvascular dysfunction after closed soft-tissue trauma

Journal of Bone and Joint Surgery. British Volume 85(1): 126-132

A major pathway of closed soft-tissue injury is failure of microvascular perfusion combined with a persistently enhanced inflammatory response. We therefore tested the hypothesis that hypertonic hydroxyethyl starch (HS/HES) effectively restores microcirculation and reduces leukocyte adherence after closed soft-tissue injury. We induced closed soft-tissue injury in the hindlimbs of 14 male isoflurane-anaesthetised rats. Seven traumatised animals received 7.5% sodium chloride-6% HS/HES and seven isovolaemic 0.9% saline (NS). Six non-injured animals did not receive any additional fluid and acted as a control group. The microcirculation of the extensor digitorum longus muscle (EDL) was quantitatively analysed two hours after trauma using intravital microscopy and laser Doppler flowmetry, i.e. erythrocyte flux. Oedema was assessed by the wet-to-dry-weight ratio of the EDL. In NS-treated animals closed soft-tissue injury resulted in massive reduction of functional capillary density (FCD) and a marked increase in microvascular permeability and leukocyte-endothelial cell interaction as compared with the control group. By contrast, HS/HES was effective in restoring the FCD to 94% of values found in the control group. In addition, leukocyte rolling decreased almost to control levels and leukocyte adherence was found to be reduced by approximately 50%. Erythrocyte flux in NS-treated animals decreased to 90 +/- 8% (mean SEM), whereas values in the HS/HES group significantly increased to 137 +/- 3% compared with the baseline flux. Oedema in the HS/HES group (1.06 +/- 0.02) was significantly decreased compared with the NS-group (1.12 +/- 0.01). HS/HES effectively restores nutritive perfusion, decreases leukocyte adherence, improves endothelial integrity and attenuates oedema, thereby restricting tissue damage evolving secondary to closed soft-tissue injury. It appears to be an effective intervention, supporting nutritional blood flow by reducing trauma-induced microvascular dysfunction.

Please choose payment method:

(PDF emailed within 0-6 h: $19.90)

Accession: 050326844

Download citation: RISBibTeXText

PMID: 12585591

DOI: 10.1302/0301-620x.85b1.11870

Related references

Small volume resuscitation with 7.5% hypertonic saline, hydroxyethyl starch 130/0.4 solution and hypertonic sodium chloride hydroxyethyl starch 40 injection reduced lung injury in endotoxin shock rats: comparison with saline. Pulmonary Pharmacology and Therapeutics 25(1): 27-32, 2012

Less impairment of hemostasis and reduced blood loss in pigs after resuscitation from hemorrhagic shock using the small-volume concept with hypertonic saline/hydroxyethyl starch as compared to administration of 4% gelatin or 6% hydroxyethyl starch solution. Anesthesia and Analgesia 106(4): 1078-86 Table of Contents, 2008

Small volume resuscitation from hemorrhagic shock in dogs with hypertonic saline hydroxyethyl starch solutions. Anesthesiology 69(3A): A847, 1988

Acute preoperative hemodilution in cardiac surgery: volume replacement with a hypertonic saline-hydroxyethyl starch solution. Journal of Cardiothoracic and Vascular Anesthesia 5(1): 23-28, 1991

Cerebrovascular effects of small volume resuscitation from hemorrhagic shock: comparison of hypertonic saline and concentrated hydroxyethyl starch in dogs. Journal of Neurosurgical Anesthesiology 3(1): 47-55, 1991

Comparison of the in vitro effects of saline, hypertonic hydroxyethyl starch, hypertonic saline, and two forms of hydroxyethyl starch on whole blood coagulation and platelet function in dogs. Journal of Veterinary Emergency and Critical Care 25(4): 474-487, 2016

Hypertonic hydroxyethyl starch restores hepatic microvascular perfusion in hemorrhagic shock. American Journal of Physiology 266(5 Pt 2): H1927-H1934, 1994

Temporal profile of microvascular disturbances in rat tibial periosteum following closed soft tissue trauma. Langenbeck's Archives of Surgery 388(5): 323-330, 2003

Hypertonic saline--hydroxyethyl starch in trauma resuscitation. Journal of the Royal Army Medical Corps 152(1): 6, 2006

Soft tissue trauma: linking systemic hypothermia to sustained microvascular dysfunction. Critical Care Medicine 33(8): 1879-1881, 2005

Improvement of Impaired Pancreatic Tissue Oxygen Tension after Isovolemic Hemodilution with Hydroxyethyl Starch Plus HBOC in Comparison to Hydroxyethyl Starch and Ringer Solution in Acute Pancreatitis. Anesthesiology Abstracts of Scientific Papers Annual Meeting ( ): Abstract No A-379, 2002

Small volume resuscitation for acute intraoperative haemorrhage: comparison of 7.5% saline and 6% hydroxyethyl starch. Anestezjologia Intensywna Terapia 41(1): 6, 2009

Volume therapy with hypertonic saline hydroxyethyl starch solution in cardiac surgery. Anaesthesia 45(11): 928-934, 1990

Hemodynamic effects of volume replacement with saline solution and hypertonic hydroxyethyl starch in dogs. Acta Cirurgica Brasileira 24(2): 87-92, 2009

Hypertonic-hyperoncotic volume replacement (7.5% NaCl/10% hydroxyethyl starch 200.000/0.5) in patients with coronary artery stenoses. Zentralblatt für Chirurgie 118(5): 257-63; Discussion 264-6, 1993