Influence of different volume therapies on platelet function in the critically ill
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Both albumin and synthetic colloids such as hydroxyethyl starch (HES) solution are used to optimize hemodynamics in the critically ill. The influence of different long-term infusion regimes on platelet function was studied.
Prospective, randomized study.
Clinical investigation on a university hospital surgical intensive care unit.
Twenty-eight consecutive trauma patients (injury severity score>15 points) and 28 consecutive nontraumatized surgical patients with sepsis.
The patients received either 20% human albumin (HA trauma,n=14; HA sepsis,n=14) or 10% low-molecular-weight HES solution HES 200/0.5 (HES trauma,n=14; HES sepsis;n=14) for 5 days to maintain central venous pressure and/or pulmonary capillary wedge pressure between 12 and 16 mmHg.
Measurements and results
Platelet function was assessed by aggregometry (=turbidimetric technique) using adenosine diphosphate 2.0 μmol/l, collagen 4 μl/ml, and epinephrine 25 μmol/l as inductors. Arterial blood was sampled on the day of admission or the day of diagnosis of sepsis (=baseline value) and over the next 5 days. Standard coagulation parameters (antithrombin III, fibrinogen, partial thromboplastin time) were also measured. Total use of HES by the 5th day totalled 4870±990 ml in the trauma and 3260±790 ml in the sepsis patients (HA trauma: 1850±380 ml; HA sepsis: 1790±400 ml). Maximum platelet aggregation decreased significantly during the first 2–3 days after baseline in all groups. At the end of the investigation period, platelet aggregation variables had recovered and reached (or even exceeded) baseline values. Within the entire investigation period, the course of platelet aggregation variables did not differ significantly between HA and HES-treated patients irrespective of whether they were trauma or sepsis patients.
Alterations in hemostasis may occur for several reasons in the critically ill. Human albumin is the preferred first-line volume therapy in patients at risk for coagulation disorders. With respect to platelet function, volume replacement with (lower-priced) low-molecular-weight HES solutions can be recommended in this situation without any risk.
Key wordsCritically ill Sepsis Trauma Volume therapy Platelet function Aggregometry Hydroxyethyl starch solution Albumin
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- 1.Bick RL (1992) Platelet function defects: a clinical review. Semin Thromb Hemost 18:167–185Google Scholar
- 2.Shattil SJ, Hoxie JA, Cunningham M, Brass LF (1985) Changes in the platelet membrane glycoprotein IIb-IIIa complex during platelet activation. J Biol Chem 260:11107–11114Google Scholar
- 3.George JN, Picket E, Sauceman S, McEver RP, Kunicki TJ, Kieffer N, Newman PJ (1986) Platelet surface glycoproteins. J Clin Invest 78:340–348Google Scholar
- 4.Weiss HJ (1982) Antiplatelet drugs: Pharmacological aspects: In: Weiss HJ (ed) Platelets: pathophysiology and antiplatelet drug therapy. Liss, New York, pp 45–58Google Scholar
- 5.Morisaki H, Sibbald WJ (1993) Issues in colloid and transfusion therapy of sepsis. In: Vinvent JL (ed) Yearbook of intensive care and emergency medicine. Springer, Berlin Heidelberg New York, pp 357–372Google Scholar
- 6.Lockwood DN, Bullen C, Machin SJ (1988) A severe coagulopathy following volume replacement with hydroxyethyl starch in a Jehovah's witness. Anaesthesia 43:391–393.Google Scholar
- 7.Emmerson TE (1989) Unique features of albumin: a brief review. Crit Care Med 17:690–694Google Scholar
- 8.Edwards JD (1994) A new debate: colloid versus colloid. In: Vincent JL (ed) Yearbook of intensive care and emergency medicine. Springer, Berlin Heidelberg New York, pp 152–164Google Scholar
- 9.Strauss RG (1988) Volume replacement and coagulation: a comparative review. J Cardiothorac Anesth 2[Suppl 1]:24–32Google Scholar
- 10.MacIntyre E, Mackie IJ, Ho D, Tinker J, Bullen C, Machin SJ (1985) The haemostatic effects of hydroxyethyl starch (HES) used as a volume expander. Intensive Care Med 11:300–303Google Scholar
- 11.Baker SP, O'Neill B (1976) The injury severity score: an update. J Trauma 16:882–888Google Scholar
- 12.Members of the American College of Chest Physicians/Society of Critical Care Medicine Conference Committee (1992) American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 20:864–874Google Scholar
- 13.Born G, Cross M (1963) The aggregation of blood platelets. J Physiol 168:178–182Google Scholar
- 14.Scherer R, Kox W (1993) Consumptive coagulopathies in the critically ill. In: Vincent JL (ed) Yearbook of intensive care and emergency medicine. Springer, Berlin Heidelberg New York, pp 629–637Google Scholar
- 15.Baughman RP, Lower EE, Flessa HC, Tollerud DJ (1993) Thrombocytopenia in the intensive care patients: Chest 104:1243–1247Google Scholar
- 16.Bowie EJW, Owen CA (1984) The clinical and laboratory diagnosis of hemorrhagic disorders. In: Mishler PA (ed) Disorders of hemostasis. Grune & Stratton, Orlando, pp 43–72Google Scholar
- 17.Bone RC (1992) Sepsis and coagulation: an important link. Chest 101: 594–595Google Scholar
- 18.Demeyere R (1990) Coagulation in cardiac surgery. Curr Opin Anaesth 3:77–85Google Scholar
- 19.Ellison N, Addonizio VP, Niewarowski S (1980) Platelet protection during cardiopulmonary bypass with albumin prime and prostaglandin E1 infusion. Anesthesiology 53:S168Google Scholar
- 20.Hicks GLJ, Jensen LA, Norsen LH, Quinn JR, Stewart SS, DeWeese JA (1985) Platelet inhibitors and hydroxyethy starch: safe and cost-effective interventions in coronary artery surgery. Ann Thorac Surg 39:422–425Google Scholar
- 21.Korttila K, Groehn P, Gordin A, Sundberg S, Salo H, Nissinen E, Matilla MAK (1984) Effect of hydroxyethyl starch and dextran on plasma volume and blood hemostasis and coagulation. J Clin Pharmacol 24:273–282Google Scholar
- 22.Strauss RG, Stansfield C, Henriksen RA (1988) Pentastarch may exert fewer effects on coagulation than hetastarch. Transfusion 28:257–260Google Scholar
- 23.London MJ, Ho SJ, Triedman JK, Verrier ED, Levin J, Merrick SH, Hanley FL, Browner WS, Mangano DT (1989) A randomized clinical trial of 10% pentastarch (low molecular weight hydroxyethyl starch) versus 5% albumin for plasma volume expansion after cardiac operations. J Thorac Cardiovasc Surg 97:785–797Google Scholar
- 24.Kapiotis S, Quehenberger P, Eichler HG, Schwarzinger I, Pärtan Ch, Schneider B, Lechner K, Speiser W (1994) Effect of hydroxyethyl starch on the activity of blood coagulation and fibrinolysis in healthy volunteers: comparison with albumin. Crit Care Med 22:606–612Google Scholar
- 25.Sibbald WJ (1994) Fluid therapy in sepsis. In: Reinhard K, Eyrich K, Sprung C (eds) Sepsis — current perspectives in pathophysiology and therapy. (Update in intensive care and emergency medicine, vol 18) Springer, Berlin Heidelberg New York, pp 266–273Google Scholar
- 26.Cines DB (1986) Heparin: do we understand its antithrombotic actions? Chest 89:420–426Google Scholar
- 27.Kestin AS, Valeri CR, Khuri SF, Loscalzo J, Ellis PA, MacGregor EH, Birjiniuk V, Oulmet H, Pasche B, Nelson MJ, Benoit SE, Rodino LJ, Barnard MC, Michelson AD (1993) The platelet function defect of cardiopulmonary bypass. Blood 82:110–117Google Scholar
- 28.Golub R, Sorrento JJ, Cantu R, Nierman DM, Moideen A, Stein D (1994) Efficacy of albumin supplementation in the surgical intensive care unit: a prospective, randomized study. Crit Care Med 22:613–619Google Scholar