Influence of different volume therapies and pentoxifylline infusion on circulating soluble adhesion molecules in critically ill patients


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Abstract

ObjectiveTo study the influence of long-term volume therapy with different solutions and continuous administration of pentoxifylline on plasma concentrations of circulating adhesion molecules.DesignProspective, randomized study.SettingA surgical intensive care unit (ICU) of a university hospital.PatientsForty-two patients with sepsis secondary to major surgery were included.InterventionsThe patients were randomly separated into three groups. In group 1 (n equals 14), volume therapy was exclusively carried out with 10% low-molecular-weight hydroxyethyl starch solution. In group 2 (n equals 14), patients exclusively received 20% human albumin for volume therapy. In group 3 (n equals 14), volume therapy was not defined and pentoxifylline was continuously given (1.4 mg/kg/hr iv).Measurements and Main ResultsFrom arterial blood samples, plasma concentrations of soluble adhesion molecules (endothelial leukocyte adhesion molecule-1 [soluble ELAM-1], intercellular adhesion molecule-1 [soluble ICAM-1], vascular cell adhesion molecule-1 [soluble VCAM-1], and soluble granule membrane protein-140) were serially measured on the day of admission to the ICU (``baseline'' value) and during the next 5 days at noon.No significant differences between the three groups were found for macrohemodynamics.Soluble ELAM-1, soluble ICAM-1, and soluble VCAM-1 plasma concentrations were markedly higher than normal values at baseline in all groups. In the hydroxyethyl starch group, soluble ELAM-1 plasma concentration decreased to the normal range, whereas it further increased in the human albumin group and was almost unchanged in the pentoxifylline group.During the study period, soluble ICAM-1 and soluble VCAM-1 plasma concentrations remained unchanged in the hydroxyethyl starch group. However, these concentrations increased in the other groups. Soluble granule membrane protein-140 increased significantly only in the human albumin group (483 plus minus 103 to 683 plus minus 94 ng/mL). In the hydroxyethyl starch-treated patients, Acute Physiology and Chronic Health Evaluation II score decreased significantly (from 24.3 plus minus 3.4 at baseline to 17.0 plus minus 3.3 at the end of the study period). Only PaO2/FIO2 was correlated to plasma concentrations of adhesion molecules.ConclusionsSepsis is associated with markedly increased plasma concentrations of adhesion molecules, indicating endothelial activation or damage. By long-term volume therapy with hydroxyethyl starch solution, these concentrations remained unchanged or even decreased, whereas in patients in whom human albumin was infused or pentoxifylline was given continuously, plasma concentration of soluble adhesion molecules further increased.(Crit Care Med 1996; 24:385-391)

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