The effects of colloids or crystalloids on acute respiratory distress syndrome in swine (Sus scrofa) models with severe sepsis: analysis on extravascular lung water, IL-8, and VCAM-1

Rismala Dewi, Bambang Supriyatno, Amir S. Madjid, Gunanti Gunanti, Munar Lubis



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 aim of the study was to determine the effects of colloid or crystalloid 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, IPB, using 22 healthy swine models with a body weight of 8 to 12 kg. Subjects were randomly allocated to receive either colloid or crystalloid fluid resuscitation. After administration 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. Analysis of data using the Wilcoxon test , Kolmogorov-Smirnov test, Mann-Whitney test, unpaired t test.

Results: Mild ARDS was more prevalent in the colloid group, while moderate ARDS was more frequent in the crystalloid group. EVLW elevation was lower in the colloid compared to 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, but not with IL-8 or VCAM-1 levels.


ARDS; colloid; crystalloid; EVLW; sepsis

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  1. Watson RS, Carcillo JA, Linde-Zwirble WT, Clermont G, Lidicker J, Angus DC. The epidemiology of severe sepsis in children in the United States. Am J Respir Crit Care Med. 2003;167(5):695–701.
  2. Medical Record Department of Child Health, Cipto Mangunkusumo Hospital. Unpublished Data. 2008. Indonesian.
  3. Monahan LJ. Acute respiratory distress syndrome. Curr Probl Pediatr Adolesc Health Care. 2013;43:278–84.
  4. Dahlem P, van Aalderen WM, Bos AP. Pediatric acute lung injury. Paediatr Respir Rev. 2007;8(4):348–62.
  5. Abraham E, Singer M. Mechanism of sepsis-induced organ dysfunction. Crit Care Med. 2007;35(10):2408–16.
  6. Kirov MY, Kuzkov VV, Bjertnaes LJ. Extravascular lung water in sepsis. Intensive Care Med. 2005;6:449–60.
  7. Martin GS, Eaton S, Mealer M, Moss M. Extravascular lung water in patients with severe sepsis: a prospective cohort study. Crit Care. 2005;9(2):R74–82.
  8. Orbegozo Cortes D, Santacruz C, Donadello K, Nobile L, Taccone FS. Colloids for fluid resuscitation: what is their role in patients with shock?. Minerva Anestesiol. 2014;80(8):963–9.
  9. Cordemans C, De laet I, Van Regenmortel N, Schoonheydt K, Dits H, Huber W, et al. Fluid management in critically ill patients: the role of extravascular lung water, abdominal hypertension, capillary leak, and fluid balance. Ann Intensive Care. 2012;2(Suppl1):S1–12.
  10. Jackson P, Cockroft P. Handbook of pig medicine. 1st ed. New York: Elsevier Health Sciences; 2007. p. 1–45.
  11. Khemani RG, Wilson DF, Esteban A, Ferguson ND. Evaluating the Berlin definition in pediatric ARDS. Intensive Care Med. 2013;39(12):2213–6.
  12. Matute-Bello G, Downey G, Moore BB, Groshong SD, Matthay MA, Slutsky AS, et al. An official American Thoracic Society workshop report: features and measurements of experimental acute lung injury in animals. Am J Respir Cell Mol Biol. 2011;44(5):725–38.
  13. Chung FT, Lin HC, Kuo CH, Yu CT, Chou CL, Lee KY, et al. Extravascular lung water correlates multiorgan dysfunction syndrome and mortality in sepsis. PLoS One. 2010;5(12):e15265.
  14. Lubrano R, Cecchetti C, Elli M, Tomasello C, Guido G, Di Nardo M, et al. Prognostic value of extravascular lung water index in critically ill children with acute respiratory failure. Intensive Care Med. 2011;37(1):124–31.
  15. Berkowitz DM, Danai PA, Eaton S, Moss M, Martin GS. Accurate characterization of extravascular lung water in acute respiratory distress syndrome. Crit Care Med. 2008;36(6):1803–9.
  16. Jacob M, Bruegger D, Rehm M, Welsch U, Conzen P, Becker BF. Contrasting effects of colloid and crystalloid resuscitation fluids on cardiac vascular permeability. Anesthesiology. 2006;104(6):1223–31.
  17. van der Heijden M, Verheij J, van Nieuw Amerongen GP, Groeneveld AB. Crystalloid or colloid fluid loading and pulmonary permeability, edema, and injury in septic and nonseptic critically ill patients with hypovolemia. Crit Care Med. 2009;37(4):1275–81.
  18. Mehta D, Malik AB. Signaling mechanisms regulating endothelial permeability. Physiol Rev. 2006;86(1):279–367.
  19. Remick DG. Interleukin-8. Crit Care Med. 2005;33(12Suppl):S466–7.
  20. Pierrakos C, Vincent JL. Sepsis biomarkers: a review. Crit Care. 2010;14(1):R15.
  21. Fanelli V, Vlachou A, Ghannadian S, Simonetti U, Slutsky AS, Zhang H. Acute respiratory distress syndrome: new definition, current and future therapeutic options. J Thorac Dis. 2013;5(3):326–34.
  22. Macdonald SP, Stone SF, Neil CL, van Eeden PE, Fatovich DM, Arendts G, et al. Sustained elevation of resistin, NGAL and IL-8 are associated with severe sepsis/septic shock in the emergency department. PLoS One. 2014;9(10):e110678.

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