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ABSTRAKLatar belakang. Acute respiratory distress syndrome (ARDS) merupakan salah
satu komplikasi fatal sepsis berat. Penggunaan cairan koloid sebagai cairan
resusitasi dapat menurunkan kejadian ARDS lebih banyak karena memiliki berat
molekul yang lebih tinggi dibandingkan cairan kristaloid. Peningkatan
extravascular lung water (EVLW), kadar interleukin-8 (IL-8) dan vascular cell
adhesion molecule-1 (VCAM-1) telah diteliti sebagai indikator penting yang
berperan dalam patogenesis ARDS. Penelitian pada hewan coba diharapkan dapat
memberikan penjelasan yang lebih baik mengenai patofisiologi ARDS yang
kompleks dan sulit dimengerti.
Tujuan. Mengungkap pengaruh cairan koloid atau kristaloid terhadap kejadian
ARDS pada model hewan coba babi dengan sepsis berat, serta menganalisis
pengaruh cairan kristaloid atau koloid terhadap peningkatan EVLW, IL-8, dan
VCAM-1.
Metode. Penelitian ini merupakan studi eksperimental acak tersamar ganda,
dilakukan di Laboratorium Bedah Eksperimental, Fakultas Kedokteran Hewan,
Institut Pertanian Bogor, dengan menggunakan babi (Sus scrofa) yang sehat
berusia 2-3 bulan, berat badan 8-12 kg. Subjek dialokasikan secara acak menjadi
dua kelompok, yaitu yang mendapatkan cairan resusitasi koloid atau kristaloid.
Setelah pemberian endotoksin 50 μg/kg, tanda klinis ARDS, EVLW, IL-8, dan
VCAM-1 dipantau saat sepsis, sepsis berat, 1 jam, dan 3 jam pasca-resusitasi
cairan. Tiga jam pasca-resusitasi, dilakukan eutanasia pada babi, kemudian
spesimen jaringan paru diambil untuk pemeriksaan histopatologi.
Hasil Utama. ARDS kategori ringan lebih banyak terdapat pada kelompok
koloid, sedangkan ARDS kategori sedang lebih banyak pada kelompok kristaloid.
Rerata skor cedera paru pada kelompok koloid lebih rendah dibandingkan dengan
kristaloid (0,4 vs. 0,7; p=0,001). Peningkatan EVLW lebih sedikit terjadi pada
kelompok koloid dibandingkan dengan kristaloid pada 1 jam (1,0 vs. 3,0
mL/kgbb; p=0,030) dan 3 jam pasca-resusitasi (2,7 vs. 6,3 mL/kgbb; p=0,034).
Pada kedua kelompok, kadar IL-8 meningkat secara bermakna setelah pemberian
endotoksin (103,1 vs. 3854,5 pg/mL; p=0,012 pada kelompok koloid dan 125,0
vs. 4419,3 pg/mL; p=0,003 pada kelompok kristaloid). Nilai kadar IL-8 dan
VCAM-1 tidak berbeda bermakna antara kedua kelompok.
Simpulan: Penggunaan cairan koloid sebagai cairan resusitasi tidak menurunkan
kemungkinan kejadian ARDS dibandingkan kristaloid. Cairan koloid
berhubungan dengan peningkatan EVLW dan skor cedera paru yang lebih rendah
dibandingkan dengan cairan kristaloid, tetapi tidak pada kadar IL-8 dan VCAM-1.;
ABSTRACTBackground. Acute respiratory distress syndrome (ARDS) is a fatal complication
of severe sepsis. Due to its higher molecular weight, the use of colloids in fluid
resuscitation may be associated with fewer cases of ARDS compared to
crystalloids. Extravascular lung water (EVLW) elevation and levels of
interleukin-8 (IL-8) and vascular cell adhesion molecule-1 (VCAM-1) have been
studied as indicators playing a role in the pathogenesis of ARDS. The use of
animal models may provide a better understanding of the complex and poorly
understood pathophysiology of ARDS.
Objectives. To determine the effects of colloid or crystalloid fluid resuscitation
on the incidence of ARDS, elevation of EVLW, and levels of IL-8 and VCAM-1,
in swine models with severe sepsis.
Methods. This was a randomized trial conducted at the Laboratory of
Experimental Surgery, School of Veterinary Medicine, Institut Pertanian Bogor,
using healthy swine (Sus scrofa) models aged 2 to 3 months with a body weight
of 8 to 12 kg. Subjects were randomly allocated to receive either colloid or
crystalloid fluid resuscitation. After administration of 50 μg/kgbw of endotoxin,
clinical signs of ARDS, EVLW, IL-8, and VCAM-1 were monitored during
sepsis, severe sepsis, and one- and three hours after fluid resuscitation. Three
hours after resuscitation, euthanasia was performed on the animal and the lung
tissue specimen was taken for histopathological examination.
Results. Mild ARDS was more prevalent in the colloid group, while moderate
ARDS was more frequent in the crystalloid group. Mean lung injury score was
lower in colloid compared to crystalloid group (0.4 vs. 0.7; p=0.001). The
increase in EVLW was lower in the colloid compared to the crystalloid group both
at one hour (1.0 vs. 3.0 mL; p=0.030) and three hours post-resuscitation (2.7 vs.
6.3 mL/kg; p=0.034). In both groups, IL-8 levels were significantly higher after
endotoxin administration (103.1 vs. 3854.5 pg/mL; p=0.012 in the colloid group
and 125.0 vs. 4419.3 pg/mL; p=0.003 in the crystalloid group). There was no
significant difference in IL-8 and VCAM-1 levels between the two groups.
Conclusion. The use of colloids in fluid resuscitation does not decrease the
probability of ARDS events compared to crystalloids. Compared to crystalloids,
colloids are associated with a lower increase in EVLWI and a lower mean lung
injury score, but not with IL-8 or VCAM-1 levels.;Background. Acute respiratory distress syndrome (ARDS) is a fatal complication
of severe sepsis. Due to its higher molecular weight, the use of colloids in fluid
resuscitation may be associated with fewer cases of ARDS compared to
crystalloids. Extravascular lung water (EVLW) elevation and levels of
interleukin-8 (IL-8) and vascular cell adhesion molecule-1 (VCAM-1) have been
studied as indicators playing a role in the pathogenesis of ARDS. The use of
animal models may provide a better understanding of the complex and poorly
understood pathophysiology of ARDS.
Objectives. To determine the effects of colloid or crystalloid fluid resuscitation
on the incidence of ARDS, elevation of EVLW, and levels of IL-8 and VCAM-1,
in swine models with severe sepsis.
Methods. This was a randomized trial conducted at the Laboratory of
Experimental Surgery, School of Veterinary Medicine, Institut Pertanian Bogor,
using healthy swine (Sus scrofa) models aged 2 to 3 months with a body weight
of 8 to 12 kg. Subjects were randomly allocated to receive either colloid or
crystalloid fluid resuscitation. After administration of 50 μg/kgbw of endotoxin,
clinical signs of ARDS, EVLW, IL-8, and VCAM-1 were monitored during
sepsis, severe sepsis, and one- and three hours after fluid resuscitation. Three
hours after resuscitation, euthanasia was performed on the animal and the lung
tissue specimen was taken for histopathological examination.
Results. Mild ARDS was more prevalent in the colloid group, while moderate
ARDS was more frequent in the crystalloid group. Mean lung injury score was
lower in colloid compared to crystalloid group (0.4 vs. 0.7; p=0.001). The
increase in EVLW was lower in the colloid compared to the crystalloid group both
at one hour (1.0 vs. 3.0 mL; p=0.030) and three hours post-resuscitation (2.7 vs.
6.3 mL/kg; p=0.034). In both groups, IL-8 levels were significantly higher after
endotoxin administration (103.1 vs. 3854.5 pg/mL; p=0.012 in the colloid group
and 125.0 vs. 4419.3 pg/mL; p=0.003 in the crystalloid group). There was no
significant difference in IL-8 and VCAM-1 levels between the two groups.
Conclusion. The use of colloids in fluid resuscitation does not decrease the
probability of ARDS events compared to crystalloids. Compared to crystalloids,
colloids are associated with a lower increase in EVLWI and a lower mean lung
injury score, but not with IL-8 or VCAM-1 levels., Background. Acute respiratory distress syndrome (ARDS) is a fatal complication
of severe sepsis. Due to its higher molecular weight, the use of colloids in fluid
resuscitation may be associated with fewer cases of ARDS compared to
crystalloids. Extravascular lung water (EVLW) elevation and levels of
interleukin-8 (IL-8) and vascular cell adhesion molecule-1 (VCAM-1) have been
studied as indicators playing a role in the pathogenesis of ARDS. The use of
animal models may provide a better understanding of the complex and poorly
understood pathophysiology of ARDS.
Objectives. To determine the effects of colloid or crystalloid fluid resuscitation
on the incidence of ARDS, elevation of EVLW, and levels of IL-8 and VCAM-1,
in swine models with severe sepsis.
Methods. This was a randomized trial conducted at the Laboratory of
Experimental Surgery, School of Veterinary Medicine, Institut Pertanian Bogor,
using healthy swine (Sus scrofa) models aged 2 to 3 months with a body weight
of 8 to 12 kg. Subjects were randomly allocated to receive either colloid or
crystalloid fluid resuscitation. After administration of 50 μg/kgbw of endotoxin,
clinical signs of ARDS, EVLW, IL-8, and VCAM-1 were monitored during
sepsis, severe sepsis, and one- and three hours after fluid resuscitation. Three
hours after resuscitation, euthanasia was performed on the animal and the lung
tissue specimen was taken for histopathological examination.
Results. Mild ARDS was more prevalent in the colloid group, while moderate
ARDS was more frequent in the crystalloid group. Mean lung injury score was
lower in colloid compared to crystalloid group (0.4 vs. 0.7; p=0.001). The
increase in EVLW was lower in the colloid compared to the crystalloid group both
at one hour (1.0 vs. 3.0 mL; p=0.030) and three hours post-resuscitation (2.7 vs.
6.3 mL/kg; p=0.034). In both groups, IL-8 levels were significantly higher after
endotoxin administration (103.1 vs. 3854.5 pg/mL; p=0.012 in the colloid group
and 125.0 vs. 4419.3 pg/mL; p=0.003 in the crystalloid group). There was no
significant difference in IL-8 and VCAM-1 levels between the two groups.
Conclusion. The use of colloids in fluid resuscitation does not decrease the
probability of ARDS events compared to crystalloids. Compared to crystalloids,
colloids are associated with a lower increase in EVLWI and a lower mean lung
injury score, but not with IL-8 or VCAM-1 levels.]
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