The Impact of Fluid Therapy on Microcirculation and Tissue Oxygenation in Hypovolemic Patients: a Review

Overview

Journal Intensive Care Med

Specialty Critical Care

Date 2010 May 27

PMID 20502873

Citations 18

Authors

Joachim Boldt

Can Ince

Affiliations

Soon will be listed here.

Abstract

Purpose: An optimal volume replacement strategy aims to restore systemic hemodynamics with the ultimate goals of improving organ perfusion and microcirculation for sustaining adequate tissue oxygenation. This review presents the (patho)physiological basis of hypovolemia, microcirculation, and tissue oxygenation and presents a literature review on the effects of plasma substitutes on microperfusion and oxygenation in the clinical setting.

Methods: Literature review of the effects of fluid therapy on microcirculation and tissue oxygenation using PubMed search including original papers in English from 1988 to 2009.

Results: We identified a total of 14 articles dealing with the effects of different crystalloids and colloids on organ perfusion, microcirculation, and tissue oxygenation in patients. The results are divergent, but there is a general trend that colloids are superior to crystalloids in improving organ perfusion, microcirculation, and tissue oxygenation. Due to the limited number of studies and different study conditions, a meta-analysis on the effects of the volume replacement strategies on microcirculation is not possible.

Conclusions: Improving the microcirculation by volume replacement appears to be a promising issue when treating the critically ill. The growing insights from animal experiments have to be translated into the clinical setting to identify the optimal fluid regimen for correcting hypovolemia. New techniques for monitoring microcirculation at the bedside might provide such endpoints, although these have to be validated also in the clinical setting. Whether improved microperfusion and tissue oxygenation by fluid therapy will also improve patient outcomes will have to be proven by future studies.

Citing Articles

Effects of impaired microvascular flow regulation on metabolism-perfusion matching and organ function.

Roy T, Secomb T Microcirculation. 2020; 28(3):e12673.

PMID: 33236393 PMC: 9119019. DOI: 10.1111/micc.12673.

Blood Loss Estimation in Small Animals and Assessment of a Pictorial Tool to Improve Accuracy in a Global Population of Veterinary Anesthesia Staff.

Cumming S, Martinez-Taboada F Front Vet Sci. 2020; 7:212.

PMID: 32457920 PMC: 7221018. DOI: 10.3389/fvets.2020.00212.

Association between sublingual microcirculation, tissue perfusion and organ failure in major trauma: A subgroup analysis of a prospective observational study.

Domizi R, Damiani E, Scorcella C, Carsetti A, Castagnani R, Vannicola S PLoS One. 2019; 14(3):e0213085.

PMID: 30835764 PMC: 6400441. DOI: 10.1371/journal.pone.0213085.

Narrative reviews from a fraudulent author: reasons to retract.

Hartog C, Perner A Intensive Care Med. 2019; 45(5):719-721.

PMID: 30762081 DOI: 10.1007/s00134-019-05558-5.

Effects of Fluids on the Macro- and Microcirculations.

Bennett V, Vidouris A, Cecconi M Crit Care. 2018; 22(1):74.

PMID: 29558989 PMC: 5861604. DOI: 10.1186/s13054-018-1993-1.

References

Kellum J, Song M, Almasri E . Hyperchloremic acidosis increases circulating inflammatory molecules in experimental sepsis. Chest. 2006; 130(4):962-7. DOI: 10.1378/chest.130.4.962. View

Ehrly A, Landgraf H . Influence of intravenous infusions of hydroxyethylstarch (HES) (MW 40,000 and 450,000) on the blood flow properties of healthy volunteers. Angiology. 1985; 36(1):41-4. DOI: 10.1177/000331978503600107. View

Arkilic C, Taguchi A, Sharma N, Ratnaraj J, Sessler D, Read T . Supplemental perioperative fluid administration increases tissue oxygen pressure. Surgery. 2003; 133(1):49-55. DOI: 10.1067/msy.2003.80. View

Boldt J, Zickmann B, Herold C, Ballesteros M, Dapper F, Hempelmann G . Influence of hypertonic volume replacement on the microcirculation in cardiac surgery. Br J Anaesth. 1991; 67(5):595-602. DOI: 10.1093/bja/67.5.595. View

Boldt J . Saline versus balanced hydroxyethyl starch: does it matter?. Curr Opin Anaesthesiol. 2008; 21(5):679-83. DOI: 10.1097/ACO.0b013e32830dd05b. View

Hofmann D, Thuemer O, Schelenz C, van Hout N, Sakka S . Increasing cardiac output by fluid loading: effects on indocyanine green plasma disappearance rate and splanchnic microcirculation. Acta Anaesthesiol Scand. 2005; 49(9):1280-6. DOI: 10.1111/j.1399-6576.2005.00834.x. View

Mythen M, Salmon J, Webb A . The rational administration of colloids. Blood Rev. 1993; 7(4):223-8. DOI: 10.1016/0268-960x(93)90009-s. View

Marik P, Iglesias J, Maini B . Gastric intramucosal pH changes after volume replacement with hydroxyethyl starch or crystalloid in patients undergoing elective abdominal aortic aneurysm repair. J Crit Care. 1997; 12(2):51-5. DOI: 10.1016/s0883-9441(97)90001-0. View

Boldt J, Heesen M, Muller M, Pabsdorf M, Hempelmann G . The effects of albumin versus hydroxyethyl starch solution on cardiorespiratory and circulatory variables in critically ill patients. Anesth Analg. 1996; 83(2):254-61. DOI: 10.1097/00000539-199608000-00010. View

10.

Wang P, Hauptman J, Chaudry I . Hemorrhage produces depression in microvascular blood flow which persists despite fluid resuscitation. Circ Shock. 1990; 32(4):307-18. View

11.

Wilkes N, Woolf R, Mutch M, Mallett S, Peachey T, Stephens R . The effects of balanced versus saline-based hetastarch and crystalloid solutions on acid-base and electrolyte status and gastric mucosal perfusion in elderly surgical patients. Anesth Analg. 2001; 93(4):811-6. DOI: 10.1097/00000539-200110000-00003. View

12.

Forrest D, Baigorri F, Chittock D, Spinelli J, Russell J . Volume expansion using pentastarch does not change gastric-arterial CO2 gradient or gastric intramucosal pH in patients who have sepsis syndrome. Crit Care Med. 2000; 28(7):2254-8. DOI: 10.1097/00003246-200007000-00012. View

13.

Scheingraber S, Rehm M, Sehmisch C, Finsterer U . Rapid saline infusion produces hyperchloremic acidosis in patients undergoing gynecologic surgery. Anesthesiology. 1999; 90(5):1265-70. DOI: 10.1097/00000542-199905000-00007. View

14.

Boldt J . The balanced concept of fluid resuscitation. Br J Anaesth. 2007; 99(3):312-5. DOI: 10.1093/bja/aem219. View

15.

Rehm M, Zahler S, Lotsch M, Welsch U, Conzen P, Jacob M . Endothelial glycocalyx as an additional barrier determining extravasation of 6% hydroxyethyl starch or 5% albumin solutions in the coronary vascular bed. Anesthesiology. 2004; 100(5):1211-23. DOI: 10.1097/00000542-200405000-00025. View

16.

Russell J . Gastric tonometry: does it work?. Intensive Care Med. 1997; 23(1):3-6. DOI: 10.1007/s001340050283. View

17.

Sakr Y, Dubois M, De Backer D, Creteur J, Vincent J . Persistent microcirculatory alterations are associated with organ failure and death in patients with septic shock. Crit Care Med. 2004; 32(9):1825-31. DOI: 10.1097/01.ccm.0000138558.16257.3f. View

18.

Chappell D, Jacob M, Hofmann-Kiefer K, Conzen P, Rehm M . A rational approach to perioperative fluid management. Anesthesiology. 2008; 109(4):723-40. DOI: 10.1097/ALN.0b013e3181863117. View

19.

Rubio-Gayosso I, Platts S, Duling B . Reactive oxygen species mediate modification of glycocalyx during ischemia-reperfusion injury. Am J Physiol Heart Circ Physiol. 2006; 290(6):H2247-56. DOI: 10.1152/ajpheart.00796.2005. View

20.

JOBSIS F . Noninvasive, infrared monitoring of cerebral and myocardial oxygen sufficiency and circulatory parameters. Science. 1977; 198(4323):1264-7. DOI: 10.1126/science.929199. View