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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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Article info
Publication history
Accepted:
July 25,
1994
Footnotes
*Supported by grants from the National Institutes of Health (HL46236) and the Department of Veterans Affairs.
Identification
Copyright
© 1995 Mosby-Year Book, Inc. Published by Elsevier Inc.
