Pentafraction for superior resuscitation of the ovine thermal burn

• Published in: Critical care medicine Vol. 23; no. 2; pp. 332 - 339
• Main Authors: Brazeal, Brad A, Honeycutt, Darcy, Traber, Lillian D, Toole, Joseph G, Herndon, David N, Traber, Daniel L
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Williams & Wilkins 01-02-1995; Lippincott
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Animals; Biological and medical sciences; Blood Pressure; Burns - physiopathology; Burns - therapy; Cardiac Output; Colloids - administration & dosage; Emergency and intensive care: burns; Female; Fluid Therapy - methods; Heart Rate; Hydroxyethyl Starch Derivatives - therapeutic use; Intensive care medicine; Isotonic Solutions - administration & dosage; Lymph - physiology; Medical sciences; Plasma; Random Allocation; Resuscitation; Ringer's Lactate; Sheep; Stroke Volume; Vascular Resistance; Intensive care; Intravenous administration; Hydroxyethylstarch; Trauma; Colloid; Plasma substitute; Burn; Vertebrata; Ewe; Mammalia; Treatment; Perfusion; Animal; Sheep; Artiodactyla; Starch derivative; Ungulata
• ISSN: 0090-3493; 1530-0293
• DOI: 10.1097/00003246-199502000-00020

OBJECTIVE To determine if a new hydroxyethyl starch, pentafraction, will cause better capillary retention of fluid in thermally burned and nonburned tissues when compared with some currently used volume expanders.
DESIGN Randomized, controlled, experimental study.
SETTING University research laboratory.
SUBJECTS Twenty-one healthy adult range ewes.
INTERVENTIONS Sheep, surgically prepared for chronic study, were randomly assigned to one of three colloid groups for the resuscitation of thermal injuriesa) ovine fresh-frozen plasma group; b) pentastarch group; and c) pentafraction group. Twenty-one sheep were subjected to a 40% total body surface, third-degree flame burn under anesthesia (1.5% to 2% halothane). When awakened, the sheep received 15 mL/kg of one of the above colloids, and then lactated Ringer's solution (2 mL/hr/kg). All animals survived and were killed at 48 hrs after burn injury.
MEASUREMENTS AND MAIN RESULTS We found that cardiac index decreased and systemic vascular resistance increased in the pentastarch and plasma groups. However, cardiac index increased in the pentafraction group, while systemic vascular resistance increased by only half as much as in the other two groups. Cardiac index in the plasma group decreased significantly for the first 8 hrs, and did not return to the baseline value for 48 hrs. Systemic vascular resistance increased significantly for the first 8 hrs in both the plasma and pentastarch groups. Prefemoral lymph flow was significantly more increased in the pentastarch group, while the lung lymph/plasma oncotic gradient was maintained only by the pentafraction group.
CONCLUSIONS Pentafraction is as good, or even superior, for volume resuscitation in the burn patient, when compared with pentastarch and plasma. This conclusion is made most evident by the attenuated changes in systemic vascular resistance and cardiac index. Pentafraction decreases the fluid flux and potential subsequent edema significantly in burned tissues and effectively maintains the pulmonary microvascular integrity.(Crit Care Med 1995; 23:332-339)