Attenuation of capillary leakage by hydroxyethyl starch (130/0.42) in a porcine model of septic shock

Objectives: Capillary leakage, a frequent complication in septic shock, is characterized by loss of intravasal fluid resulting in generalized edema and hemodynamic instability despite massive fluid therapy. We have shown that administration of an established colloid 200/0.5 hydroxyethyl starch (HES) stabilized plasma volume in a porcine septic shock model. Recently, a new HES with a low molecular weight (130 kD) and lower molar substitution (0.42) has been developed. In this study, we compared effects of HES 130/0.42 and HES 200/0.5 on capillary leakage in porcine septic shock. Design: Prospective randomized, controlled animal study. Setting. University department of anesthesiology. Subjects: Fourteen pigs (22.9 +/- 2.8 kg). Interventions. Anesthetized and mechanically ventilated pigs were observed over 6 hrs. Measurement and Main Results: Septic shock was induced with fecal peritonitis (0.75 g.kg(-1) of body weight autologous feces). Animals were allocated to volume-replacement therapy with either HES 130/0.42 (n = 5) or HES 200/0.5 (n = 5) and compared with nonseptic controls receiving HES 130/0.42 (n = 4). Infusion rate was titrated to maintain a central venous pressure of 12 mm Hg. Albumin escape rate was calculated using iodine 125-labeled albumin. Plasma volume was determined using chromium-51-tagged erythrocytes. Albumin escape rate increased significantly in both groups in comparison to controls (HES 200/0.5, 45% +/- 3; HES 130/0.42, 38% +/- 5), but this increase was significantly smaller with HES 130/0.42. Both HES 200/0.5 (-14%, not significant) and HES 130/0.42 (-1%, not significant) stabilized plasma volume compared with controls. Systemic oxygenation was not significantly altered in either group. Conclusions: In this porcine septic shock model, HES 130/0.42 attenuated capillary leakage significantly more effectively than HES 200/0.5.