Comparison of Hydroxyethyl starch 130/0.4 (6%) with commonly used agents in an experimental Pleurodesis model

Hasan Oğuz Kapicibasi,Hasan Ali Kiraz,Nazli Demir Gök

doi:10.1186/s12890-020-01260-1

Abstract

BackgroundHydroxyethyl Starch (HES) 130/0.4 (6%) is a commonly used intravascular volume expander with anti-inflammatory and antioxidant properties. In this study, we aimed to compare the histopathologic activity of HES 130/0.4 (6%) with various widely-used agents in pleurodesis.MethodsForty male Wistar-Albino rats were divided into five groups: controls, povidone-iodine recipients (PI group), sterile talcum recipients (Talcum group), autologous blood recipients (AB group) and HES 130/0.4 (6%) recipients (HES group). Thirty days after application of agents, pleural and lung tissues were resected. Evaluation was performed via macroscopic scoring (adhesion) and specimens were stained with H&E for microscopic examination (inflammation and fibrosis).ResultsHES recipients had significantly higher adhesion compared to controls (lower grade 0, higher grade 1 frequency vs. controls), they were found to have significantly lower frequency of grade 2 adhesion (vs. PI, Talc and AB) and grade 3 adhesion (vs. AB), indicating that the adhesion-generating properties of HES were only superior to the control group. HES recipients had significantly higher inflammatory grades compared to controls (lower grade 0, higher grade 1 frequency), while they had lower grades compared to the PI, Talc and AB groups. Although the PI, Talc and AB groups were statistically similar in most comparisons, we observed a trend towards higher success with the use of Talc and especially AB.ConclusionOur results do not support a role for HES in pleurodesis. We believe that the autologous blood method remains as an effective and successful procedure without side effects.

Highlights

Hydroxyethyl Starch (HES) 130/0.4 (6%) is a commonly used intravascular volume expander with antiinflammatory and antioxidant properties
There was no significant difference between the frequency of grade 2 and 3 adhesions in the comparison of the PI, Talc and autologous blood (AB) groups, we observed a trend towards higher frequency of grade 3 adhesion in the AB group (42.9%) compared to the Talc (14.3%) and PI (0%) groups (Table 1)
HES recipients had significantly higher adhesion compared to controls, they were found to have significantly lower frequency of grade 2 adhesion and grade 3 adhesion, indicating that the adhesion-generating properties of HES were only superior to the control group

Summary

Introduction

Hydroxyethyl Starch (HES) 130/0.4 (6%) is a commonly used intravascular volume expander with antiinflammatory and antioxidant properties. While adhesion can be achieved mechanically by abrasion via thoracoscopy or thoracotomy, chemical pleurodesis is very common with the application of an agent via thoracoscopy and chest. An ideal agent for chemical pleurodesis should be easy to apply, effective, accessible, inexpensive and must have minimal side effects. Due to these prerequisites, the literature has focused on the use of autologous blood (AB) and povidone-iodine (PI) as alternatives for chemical. Hydroxyethyl starch (HES) 130/0.4 (6%) (Voluven®, Fresenius Kabi, Germany) is a corn-based intravascular volume expander that is readily used during the perioperative period and in intensive care units. HES has been reported to be associated with a reduction in the need for blood transfusion in major surgical procedures [11]

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