2 de maio de 2012

Artigo recomendado: Goal-directed Colloid Administration Improves the Microcirculation of Healthy and Perianastomotic Colon

Oliver Kimberger, M.D., Michael Arnberger, M.D., Sebastian Brandt, M.D., Jan Plock, M.D., Gisli H. Sigurdsson, M.D., Ph.D., Andrea Kurz, M.D., Luzius Hiltebrand, M.D.

Anesthesiology 2009; 110:496–504

Background: The aim of this study was to compare the effects of goal-directed colloid fluid therapy with goal-directed crystalloid and restricted crystalloid fluid therapy on healthy and perianastomotic colon tissue in a pig model of colon anastomosis surgery.

Methods: Pigs (n = 27, 9 per group) were anesthetized and mechanically ventilated. A hand-sewn colon anastomosis was performed. The animals were subsequently randomized to one of the following treatments: R-RL group, 3 ml · kg-1 · h-1 Ringer lactate (RL); GD-RL group, 3 ml · kg-1 · h-1 RL + bolus 250 ml of RL; GD-C group, 3 ml · kg-1 · h-1 RL + bolus 250 ml of hydroxyethyl starch (HES 6%, 130/0.4). A fluid bolus was administered when mixed venous oxygen saturation dropped below 60%. Intestinal tissue oxygen tension and microcirculatory blood flow were measured continuously.

Results: After 4 h of treatment, tissue oxygen tension in healthy colon increased to 150 ± 31% in group GD-C versus 123 ± 40% in group GD-RL versus 94 ± 23% in group R-RL (percent of postoperative baseline values, mean ± SD; P < 0.01). Similarly perianastomotic tissue oxygen tension increased to 245 ± 93% in the GD-C group versus 147 ± 58% in the GD-RL group and 116 ± 22% in the R-RL group (P < 0.01). Microcirculatory flow was higher in group GD-C in healthy colon.

Conclusions: Goal-directed colloid fluid therapy significantly increased microcirculatory blood flow and tissue oxygen tension in healthy and injured colon compared to goal-directed or restricted crystalloid fluid therapy.

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