Research Article| Volume 117, ISSUE 3, P340-349, March 1995

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Effects of pentafraction and hetastarch plasma expansion on lung and soft tissue transvascular fluid filtration

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      Background. Hetastarch and pentafraction are high molecular weight starch solutions designed to augment plasma oncotic pressure. Although clinical utilization of hetastarch has been limited by reported coagulation abnormalities, pentafraction is a newer derivative that appears to have few adverse hemostatic effects. We examined the ability of pentafraction to modulate lung and soft tissue transvascular fluid filtration under hypoproteinemic conditions compared with hetastarch and Ringer's lactate (LR).
      Methods. Awake, protein-depleted sheep (n=19) were prepared with lung and soft tissue lymph fistulas, and comparable infusions of 5% pentafraction (n=6), 6% hetastarch (n=6), or LR (n=7) were administered. Plasma and lymph samples were collected during 24-hour period to determine changes in protein concentrations, plasma-to-lymph oncotic gradients, and lung (QL) and soft tissue (QS) lymph flows.
      Results. QL and QS rose nearly twofold after protein depletion alone. LR infusion increased QL and QS to 8.7±1.7 and 3.1±0.6 times normoproteinemic baseline, respectively (p<0.05). In contrast, hetastarch and pentafraction infusion limited the increase in QL to 4.2±1.1 and 4.0±0.8 times normoproteinemic baseline, respectively (p<0.05 versus LR) and did not significantly increase QS. Hetastarch and pentafraction infusions increase plasma oncotic pressure by nearly 6 mm Hg, which significantly widened the plasma-to-lymph oncotic pressure gradients above preinfusion baseline by 4.7±0.7 and 3.4±0.4 mm Hg in lung and 4.6±0.7 and 3.2±0.4 mm Hg in soft tissue, respectively (p<0.05).
      Conclusions. Both hetastarch and pentafraction limit transvascular fluid filtration under hypoproteinemic conditions by augmenting plasma oncotic pressure and the plasma-to-lymph oncotic pressure gradient. Because of fewer adverse hemostatic effects pentafraction may be an improvement over current therapies in critical care fluid management.
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        • Erdmann III, AJ
        • Vaughan TR
        • Brigham KL
        • Woolverton WC
        • Staub NC
        Effect of increased vascular pressure on lung fluid balance in unanesthetized sheep.
        Circ Res. 1975; 37: 271-284
        • Kramer GC
        • Harms BA
        • Bodai BI
        • Renkin EM
        • Demling RH
        Effects of hypoproteinemia and increased vascular pressure on lung fluid balance in sheep.
        J Appl Physiol. 1983; 55: 1514-1522
        • Conhaim RL
        • Harms BA
        A simplified two-pore filtration model explains the effects of hypoproteinemia on lung and soft tissue lymph flux in awake sheep.
        Microvasc Res. 1992; 44: 14-26
        • Conhaim RL
        • Rosenfeld DJ
        • Schreiber MA
        • Baaske DM
        • Harms BA
        Effects of intravenous pentafraction on lung and soft tissue liquid exchange in hypoproteinemic sheep.
        Am J Physiol. 1993; 265: H1536-H1542
        • Demling RH
        • Harms BA
        • Kramer GC
        • Gunther R
        Acute versus sustained hypoproteinemia and post-traumatic pulmonary edema.
        Surgery. 1982; 92: 79-86
        • Dodek PM
        • Rice TW
        • Bonsignore MR
        • Yamada S
        • Staub NC
        Effects of plasmapheresis and hypoproteinemia on lung liquid conductance in awake sheep.
        Circ Res. 1986; 58: 269-280
        • Harms BA
        • Pahl AC
        • Radosevich DG
        • Starling JR
        The effects of hypoproteinemia and volume expansion on lung and soft tissue transvascular fluid filtration.
        Surgery. 1989; 105: 605-614
        • Harms BA
        • Rosenfeld DJ
        • Pahl AC
        • Conhaim RL
        • Starling JR
        Pulmonary transvascular fluid filtration response to hypoproteinemia and Hespan infusion.
        J Surg Res. 1990; 48: 408-414
        • Kramer CC
        • Harms BA
        • Bodai BI
        • Demling RH
        • Renkin EM
        Mechanisms for redistribution of plasma protein following acute protein depletion.
        Am J Physiol. 1982; 243: H803-H809
        • Strauss RG
        • Stansfield C
        • Henriksen RA
        • Villhauer PJ
        Pentastarch may cause fewer effects on coagulation than hetastarch.
        Transfusion. 1988; 28: 257-260
        • Staub NC
        • Bland RD
        • Brigham KL
        • Demling RH
        • Erdmann III, AJ
        Preparation of chronic lung lymph fistula in sheep.
        J Surg Res. 1975; 19: 315-320
        • Drake R
        • Adair R
        • Traber D
        • Gabel J
        Contamination of caudal mediastinal node efferent lymph in sheep.
        Am J Physiol. 1981; 241: H354-H357
        • Demling RH
        • Smith M
        • Gunther R
        • Wandzilak T
        • Pederson NC
        Use of a chronic prefemoral fistula for monitoring systemic capillary integrity in unanesthetized sheep.
        J Surg Res. 1981; 31: 144-146
        • Lowry OH
        • Rosebrough NJ
        • Farr AL
        • Randall RJ
        Protein measurement with the Folin phenol reagent.
        J Biol Chem. 1951; 193: 265-275
        • Demling RH
        • Wilson RF
        Decision making in surgical critical care.
        in: B C Decker, Toronto1988: 30-35
        • Heughen C
        • Niinikoski J
        • Hunt TK
        Effect of excessive infusion of saline solution on tissue oxygen transport.
        Surg Gynecol Obstet. 1972; 135: 257-260
        • Hunt TK
        • Pai MP
        The effect of varying ambient oxygen tensions on wound metabolism and collagen synthesis.
        Surg Gynecol Obstet. 1972; 135: 561-567
        • Starling EH
        On the absorption of fluids from the connective tissue spaces.
        J Physiol. 1896; 19: 312-326
        • Landis EM
        • Papenheimer JR
        Exchange of substances through the capillary walls.
        in: Hamilton WF Dow P Handbook of physiology circulation. vol 2. American Physiology Society, Washington1963: 961-1034
        • Daniels JC
        • Larson DL
        • Abston S
        • Ritzmann SE
        Serum protein profiles in thermal burns.
        J Trauma. 1974; 14: 137-162
        • Howland WS
        • Schweitzer O
        • Ragasa J
        • Jascott D
        Colloid oncotic pressure and levels of albumin and total protein during major surgical procedure.
        Surg Gynecol Obstet. 1976; 143: 592-596
        • Arakawa M
        • Jerome EH
        • Enzan K
        • Grady M
        • Staub NC
        Effects of Dextran 70 on hemodynamics and lung liquid and protein exchange in awake sheep.
        Microvasc Res. 1992; 44: 14-26
        • Gallagher TJ
        • Banner MJ
        • Barnes PA
        Large volume crystalloid resuscitation does not increase extravascular lung water.
        Anesth Analg. 1985; 64: 323-326
        • Layon AJ
        • Gallagher TJ
        Effects of hetastarch resuscitation on extravascular lung water and cardiopulmonary parameters in a sheep model of hemorrhagic shock.
        Resuscitation. 1987; 15: 257-265
        • Layon AJ
        • Gallagher TJ
        Five percent human albumin in lactated Ringer's solution for resuscitation from hemorrhagic shock: efficacy and cardiopulmonary consequences.
        Crit Care Med. 1990; 18: 410-413
        • Metildi LA
        • Shackford SR
        • Virgilio RW
        • Peters RM
        Crystalloid versus colloid in fluid resuscitation of patients with severe pulmonary insufficiency.
        Surg Gynecol Obstet. 1984; 3: 207-212
        • Weaver DW
        • Ledgerwood AM
        • Lucas CE
        • Higgins R
        • Bouwman DL
        • Johnson SD
        Pulmonary effects of albumin resuscitation for severe hypovolemic shock.
        Arch Surg. 1978; 113: 387-392