Comparison of 6% hydroxyethyl starch (6%HES130/0.4/9) and 5% albumin on volume therapy, complications, and glycocalyx degradation during major abdominal surgery
Background and Goal of Study: Volume therapy with hydroxyethyl starch has been criticized by renal impairment especially in intensive care patients. The hypothesis of this study was that 6% hydroxyethyl starch 130/0.4/9 (HES) was equally safe and effective to 5% albumin (ALB) on volume therapy during major abdominal surgery.
Materials and Methods: The present study was a single center, open-labeled randomized trial approved by institutional ethical committee. We randomly assigned 50 patients with hepatic or pancreatic surgery to HES group (n = 25) and ALB group (n =25). Patients were anesthetized by general anesthesia with thoracic epidural block. Goal-directed fluid therapy with a FloTrac/VigileoTM system was performed with a following algorism. If stroke volume variation (SVV) > 10%, or stroke volume index (SVI) < 35 ml/m2, colloid(250 ml) was infused for 15 minutes. If the rise of SVI < 10% of the previous value and mean blood pressure (MBP) < 55 mmHg, norepinephrine (0.05-0.2 microgram/kg/min) was continuously infused. The infusion rate of Ringer’s acetate solution was slightly reduced but not controlled. Total volume of infusion and transfusions, urine output, blood loss, central venous oxygen saturation (ScvO2), lactate, renal function, coagulation status, the biomarkers of glycocalyx (heparan sulfate and syndecan-1) were assessed in the two groups. Mortality and morbidity (eg. renal replacement therapy: RRT) were assessed during 28 days after surgery. Statistical analysis was made by Mann-Whitney U test and statistical significance was designated as P < 0.05.
Results and Discussion: Table shows the results of the present study. There was no significant difference except urine output between the two groups. Mortality were zero, but one patient of HES group received RRT because of severe sepsis after surgery.

Table
　	                          HES group(n =25)	  ALB group (n =25)              P value
Colloid (ml)	           1750: 1500-2100	   1500: 1500-2000	              0.13
Crystalloid (ml)	   1800: 1500-2200	   1500: 1500-2000	              0.74
Urine output (ml)	     720: 470-1065	     440: 310-560	                     <0.01
Blood loss (ml)	      615: 440-1635	     750: 500-132                         0.86
Transfusion (ml)	　	　	　
RBC	                           0: 0-280	                  0: 0-0                                  0.29
FFP	                                   0: 0-240	                  0: 0-0	                               0.16
ScvO2 (%)	                 85: 79-88	                85: 79-88	                       0.81
Lactate (mmol/L)	         2.3: 0.9-3.1	                1.8:0.9-2.5	                       0.23
Cr (mg/dl)	               0.67: 0.57-0.87	      0.73: 0.65-0.93	               0.29
PT-INR	                        1.33: 1.27-1.41	      1.27: 1.21-1.41	               0.22
Platelet (x 104)	        15.7: 13.4-20.4	      18.1: 15.5-20.8	               0.24
Heparan sulfate (μg/ml)   1: 0.8-1.1	                1.1: 0.8-1.2                   	0.51
Syndecan-1 (ng/ml)	   0.8: 0.5-2.6	            2: 0.8-2.1	                        0.97

Data were obtained at the end of surgery except creatinine (one day after surgery) and presented as median: 25 - 75 percentile.
Conclusion: 6%HES 130/0.4/9 is as safe and useful as albumin when used as colloid volume therapy in major abdominal surgery.

Comparison of 6% hydroxyethyl starch (6%HES130/0.4/9) and 5% albumin on volume therapy, complications and glycocalyx degradation during major abdominal surgery