RESUSCITATION WITH HEXTEND OR HESPAN DECREASES RESUSCITATION
VOLUME AND PULMONARY INFLAMMATION IN A MURINE MODEL
OF TRAUMA AND HEMORRHAGE
Jeffrey M Sutton, MD, Richard S Hoehn, MD, Peter L. Jernigan, MD, Amy T. Makley, MD, Steven G
Miller, MD, Jillian R Richter, PhD, Lou Ann W Friend, RVT, Rebecca M Schuster, MS, Warren Dorlac,
MD, Travis Gerlach, MD, Alex B. Lentsch, PhD, Timothy A Pritts, MD, PhD
From the Division of Trauma and Critical Care, Department of Surgery, and Institute for Military Medicine,
University of Cincinnati Medical Center, Cincinnati Ohio
Background: Initial studies investigating the resuscitative efficacy of hetastarch-containing fluids suggested
increased morbidity and mortality, but more recent studies in trauma patients have, to some extent, alleviated
these initial concerns. We hypothesized that resuscitation with hetastarch-based fluids would result in lower fluid
requirements and comparable endpoints of resuscitation.
Methods: Mice underwent splenectomy followed by pressure-targeted hemorrhage for 60 minutes and
resuscitation with either crystalloid (0.9% normal saline [NS] or lactated Ringer’s solution [LR]) or hetastarchbased (6% hetastarch in NS [Hespan] or LR [Hextend]) fluids. Mice were sacrificed at intervals to evaluate
resuscitation parameters via arterial blood gas, systemic inflammation via serum cytokine analysis, localized lung
inflammation via histology, and survival.
Results: Resuscitation with hetastarch-containing fluids required significantly less volume to reach target blood
pressure than resuscitation with their respective crystalloids (p < 0.01, Figure 1). Base deficit and lactate did not
differ between groups. Resuscitation with Hespan or Hextend significantly attenuated pulmonary inflammation as
evidenced by reduced numbers of inflammatory cells on histology compared to lungs from mice resuscitated with
their respective crystalloid (Figure 2). No differences in survival were noted between resuscitation strategies.
Conclusions: The use of hetastarch-containing fluid for resuscitation after trauma and hemorrhage results in use
of lower resuscitation fluid volumes and decreased pulmonary inflammation compared to crystalloid alone.
Hetastarch-containing fluids should be considered a therapeutic alternative to initial crystalloid resuscitation.