Abstract
Objective
Adequate restoration of intravascular volume remains an important maneuver in the management of the surgical patient. Influence of different volume replacement regimens on inflammation/endothelial activation in elderly surgical patients was assessed.
Design
Prospective, randomized study.
Setting
Surgical intensive care unit of a university-affiliated hospital.
Patients
Sixty-six patients >65 years undergoing major abdominal surgery.
Interventions
Ringer’s lactate (RL; n=22), normal saline solution (NS; n=22) or a low-molecular HES (mean molecular weight 130 kD) with a low degree of substitution (0.4; HES 130/0.4; n=22) were administered after induction of anesthesia until the 1st postoperative day (POD) to keep central venous pressure between 8–12 mmHg.
Measurements and results
C-reactive protein, interleukins (IL-6, IL-8), adhesion molecules [endothelial leukocyte adhesion molecule-1 (ELAM-1) and intercellular adhesion molecule-1 (ICAM-1)] were measured prior to volume therapy at the end of surgery, 5 h after surgery and at the morning of the 1st POD. RL patients received 10,150±1,660 ml of RL, NS patients 10,220±1,770 ml of NS and the HES-treated group 2,850±300 ml of HES 130/0.4 and 2,810±350 ml of RL. Hemodynamics were similar in all groups. CRP, IL-6 and IL-8 plasma levels increased significantly higher in both crystalloid groups (IL-6 in the NS group: increase to 407±33 pg/ml; RL: increase to 377±35 pg/dl) than in the HES-130 treated group (IL-6: increase to 197±20 pg/dl). Plasma levels of ELAM-1 and ICAM remained almost unchanged in the HES 130-, but significantly increased in the RL- and NS-treated patients.
Conclusions
In elderly patients, markers of inflammation and endothelial injury and activation were significantly higher after crystalloid- than after HES 130/0.4-based volume replacement regimens.
Similar content being viewed by others
References
Cussak RJ, Ball JAS, Rhdes A, Grounds RM (2002) Improving postoperative morbidity and mortality. Intensivmed 39:571–577
Mythen MG, Webb AR (1995) Perioperative plasma volume expansion reduces the incidence of gut mucosal hypoperfusion during cardiac surgery. Ann Surg 130:423–429
Wolf SE, Rose JK, Desai MH, Mileski JP, Barrow RE, Herndon DN (1997) Mortality determinants in massive pediatric burns. An analysis of 183 Children with or =80% TSBA burns (> or =70% full thickness). Ann Surg 225:554–565
Khandelwal P, Bohn D, Carcillo JA, Thomas NJ (2002) Pro/con clinical debate: do colloids have advantages over crystalloids in paediatric sepsis? Crit Care 6:286–288
Wilson MA, Chou MC, Spain DA, Downard PJ, Qian Q, Cheadle WG, Garrison RN (1996) Fluid resusciatation attenuates early cytokine mRNA expression after peritonitis. J Trauma 41:622–627
Perret C, Feihl F (2000) Volume expansion during septic shock. Bull Acad Natl Med 184:1621–1629
Cook TM, Day CJ (1998) Hospital mortality after urgent and emergency laparatomy in patients aged 65 years and over. Risk and prediction of risk using multiple logistic regression analysis. Br J Anaesth 80:776–781
Sinclair S, James S, Singer M (1997) Intraoperative intravascular volume optimisation and length of hospital stay after repair of proximal femoral fracture: randomised controlled trial. BMJ 315:909–912
Suffredini AF (1994) Currrent prospects for the treatment of clinical sepsis. Crit Care Med 22:S12–S18
Meissner M, Tschaikowsky K, Hutzler A, Schlick C, Schüttler J (1998) Postoperative plasma concentration of procalcitonin after different types of surgery. Intensive Care Med 24:680–684
Rink L. Cakman I, Kirchner H (1998) Altered cytokine production in the elderly. Mech Aging Dev 102:199–209
Tortorella C, Piazzolla G, Napoli N, Antonaci S (2001) Neutrophil apoptotic cell death: does it contribute to the increased infectious risk in aging? Microbios 106:129–136
Suttner SW, Sürder C, Lang K, Piper SN, Kumle B, Boldt J (2001) Does age affect liver function and hepatic acute phase response after major abdominal surgery? Intensive Care Med 27:1762–1769
Frumento RJ, Bennett-Guerrero E (2003) Systemic inflammatory response syndrome and organ dysfunction: opportunities for treatment. In: Newman MF (ed) Perioperative organ protection. A Society of Cardiovascular Anesthesiologists monograph. Lipincott Williams and Wilkins, Baltimore, pp 1–27
O’Neill PJ, Cobb LM, Ayala A, Morrison MH, Chaudry IH (1994) Aggressive fluid resuscitation following intestinal ischemia- reperfusion in immature rats prevents metabolic derangements and down-regulates interleukin-6 release. Shock 1:381–387
Geppert A, Zorn H, Delle-Kath G, Korney M, Siostronek P, Heinz G, Huber K (2003) Plasma concentrations of von Willebrand factor and intracellular adhesion molecule-1 for prediction of outcome after sucessfull cardiopulmonary resuscitation. Crit Care Med 31:805–811
Welters ID, Spangenberg U, Menzebach A, Menges T, Langefeld TW, Hempelmann G (2000) Influence of colloids on neutrophil function. Anaesthesist 49:196–201
Sillett HK, Whicher JT, Trejdowiewicz LK (1998) Effects of resuscitation fluids on T cell immune response. Br J Anaesth 81:242–243
Rhee P, Burris D, Kaufmann C, Pikoulis M, Austin B, Ling G, Harviel D, Waxman K (1998) Lactated Ringer’s solution resuscitation causes neutrophil activation after hemorrhagic shock. J Trauma 44:313–319
Rhee P, Wang D, Ruff P, Austin B, DeBraux S, Wolcott K, Buris D, Ling G, Sun L (2000) Human neutrophil acivation and increased adhesion by various resuscitation fluids. Crit Care Med 28:74–78
Sillett HK, Whicher JT, Trejdsiewicz LK (1997) Effects of resuscitation fluids on nonadaptive immune responses. Transfusion 37:953–959
Eastlund DT, Douglas MS, Choper JZ (1992) Monocyte chemotaxis and chemotactic cytokine release after exposure of hydroxyethyl. Transfusion 32:855–860
Jaeger K, Jüttner B, Heine J, Ruschulte H, Scheinichen D, Piepenbrock S (2000) Effect of hydroxyethyl starch and modified gelatine on phagocytic activity of human neutrophils and monocytes—results of a randomized, prospective clinical study. Infus Ther Transfus Med 27:256–260
Cowley HC, Heney D, Gearing AJH, Hemingway I, Webster NR (1994) Increased circulating adhesion molecule concentrations in patients with septic inflammatory response: a prospective cohort study. Crit Care Med 22:651–657
van der Heide RS, Sobotka PA, Gronte CE (1997) Effects of the free radical scavanger DMTU and mannitol on the oxygen paradox in perfused rat hearts. J Mol Cell Cardiol 19:619–620
Justics AC, Farnsworth WV, Soberman MS (1991) Reduction of myocardial infarct size by poloxamer 188 and mannitol in canine model. Am Heart J 122:671–672
Collis RE, Collins PW, Gutteridge CN, Faul A, Newland AC, Williams DM, Webb AR (1994) The effect of hydroxyethyl starch and other plasma volume substitutes on endothelial cell activation, an in vitro study. Intensive Care Med 20:37–41
Schmand J, Ayala A, Chaudry IH (1994) Effects of trauma, duration of hypotension, and resuscitation regimen on cellular immunity after hemorragic shock. Crit Care Med 22:1076–1083
Hack CE, Zeerleder S (2001) The endothelium in sepsis: source of and a target for inflammation. Crit Care Med 29 [Suppl]:S21–S27
Morisaki H, Bloos F, Keys J, Martin C, Neal A, Sibbald WJ (1994) Compared with crystalloid, colloid therapy slows progression of extrapulmonary tissue injury in septic sheep. J Appl Physiol 77:1507–1518
Lang K, Boldt J, Suttner S, Haisch G (2001) Colloids versus crystalloids and tissue oxygen tension in patients undergoing major abdominal surgery. Anesth Analg 93:405–409
Ruttmann TG, James MFM, Aronson I (1998) In vivo investigation into the effects of haemodilution with hydroxyethyl starch (200/0.5) and normal saline on coagulation. Br J Anaesth 80:612–616.
Esmon CT (2000) Are natural anticoagulants candidates for modulating the inflammatory response to endotoxin? Blood 95:1113–1116
Webb AR (1999) Crystalloid or colloid resuscitation. Are we any wiser? Crit Care 3:R25–R28
Hinder F, Subbe HD, van Aken H, Baba HA, Jahn UR, Brodner G, August Ch, Erren M, Booke M (2003) Early multiple organ failure after recurrent endotoxemia in the presence of vasoconstrictor-masked hypovolemia. Crit Care Med 31:903–909
Author information
Authors and Affiliations
Corresponding author
Additional information
This study was not supported by a pharmaceutical company.
This article has been retracted as the IRB approval for the research was misrepresented.
An erratum to this article is available at http://dx.doi.org/10.1007/s00134-011-2218-0.
About this article
Cite this article
Boldt, J., Ducke, M., Kumle, B. et al. RETRACTED ARTICLE: Influence of different volume replacement strategies on inflammation and endothelial activation in the elderly undergoing major abdominal surgery. Intensive Care Med 30, 416–422 (2004). https://doi.org/10.1007/s00134-003-2110-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00134-003-2110-7