The remaining 22 trials, with 21 participants, assessed one type of plasma expander, i. Hydroxyethyl starch an overview sciencedirect topics. Ninetythree patients presenting for firsttime coronary artery bypass graft cabg surgery were randomly allocated to receive one of three prime solutions for the cpb pump. Hydroxyethyl starch vs haemaccel in subarachnoid block medpulse. Dieterich hj 2003 recent developments in european colloid solutions. Adrac has received similar reports associated with o. All colloids are presented dissolved in a crystalloid solution.
Solutions contain particles of various molecular weights and degrees of hydroxyethyl substitution, resulting in extremely heterogeneous mixtures. In a model of severe canine haemorrhagic shock, greyhound dogs were randomly allocated to resuscitation with 0. Health professional information summary product information route of administration dosage form strength nonmedicinal ingredients intravenous solution for infusion 6% hes 0. Adrac has received similar reports associated with other plasma expanders, albumin albumex, polygeline haemaccel, and dextran. Jan 01, 2012 when compared to intravenous hydroxyethyl starches, using gelatin solutions was associated with a lower risk of acute renal failure or 0. In 20, the european medicines agency ema restricted the use of solutions containing hydroxyethyl starch hes in critically ill patients with sepsis, burns, and impaired kidney function while maintaining authorisation for the treatment of hypovolaemia due to acute blood loss when crystalloids alone are not sufficient. Data collection included duration of anesthesia and surgery, anesthetic agents and their doses, total amount of administered vasoactive agents phenylephrine, ephedrine, dopamine, or atropine, the total amount of administered crystalloids ringers acetate, colloids hydroxyethyl starch solution, hes or albumin, mannitol, red blood cell concentrates, fresh. The use of hes on critically ill patients is associated with an increased risk of death and kidney problems. They acknowledge that most previous studies that failed to detect adverse renal effects of hes in lowrisk patients used relatively insensitive markers such as urine output or circulating creatinine levels. Do not use hydroxyethyl starch solution in critically ill patients because of the increased risk for death and renal injury, the agency said today. Hence, the aim of this study was to verify whether different strategies of fluids administration can reduce mmp9 expression. A restricted analysis on the mortality effect of gelatin solutions in cardiac. Bolus therapy for hydroxyethyl starch solutions in dogs should be delivered in 5mlkg increments up to 20 mlkg. In the albumin group the mean was 240 sd 310, and in the polygeline group the.
Solution that have a higher tonicity or solute concentration. Clinically used colloid fluids include albumin, hydroxyethyl starch, gelatin, and. Mfg is 4% solution in normal saline, whereas ureabridged gelatin is a 3. Therapy was directed towards control of intracranial pressure icp and maintenance of cerebral perfusion pressure cpp. Hydroxyethyl starch is a term used to describe a synthetic class of molecules similar to glycogen. The fluid of choice for resuscitation of severe shock. The pharmacokinetics and tolerability of an intravenous infusion of the new hydroxyethyl starch 0. Effects of polygeline and hydroxyethyl starch solutions on liver functions assessed with limon in hypovolemic patients. Although polygeline and human albumin are known to cause histamine release, other substances eg hydroxyethyl starch were thought to be without effect. Hydroxyethyl starch in sodium chloride fda prescribing. An in vitro study showed hydroxyethyl starch preparation 0. Effects of polygeline and hydroxyethyl starch solutions on.
A comparison of the effects of artificial plasma substitutes. We studied and compared the effects of intravenous fluid hydroxyethyl starch and ringer lactate on blood sugar level in patients undergoing surgery under subarachnoid block. A normovolemic hemodilution technique was used with hydroxyethyl starch n 6, human albumin n 6, and polygeline n 9. Hydroxyethyl starch solutions are protected from metabolism due to a high degree of substitution proportion of glucose units substituted with hydroxyethyl groupsds or a high c2. Colloid solutions for fluid resuscitation ncbi nih. However, recent studies have provided evidence of the hyperaggregating effect on human red blood cells rbc of hydroxyethyl starch hes, one of the components of the uw solution. Fda warns of increased mortality risk with hes solution. Resuscitative fluid therapy for circulatory shock todays. Become a member of the european society of anaesthesiology. Hydroxyethyl starch definition of hydroxyethyl starch by.
They observed a significant increase in chloride and a reduction in base excess in the unbalanced group. The plasma volume expansion after infusion of dextran 70 macrodex, hydroxyethylstarch volex, polygelatin haemaccel, albumin. Early and late histamine release induced by albumin. Hydroxyethyl starch in isotonic sodium chloride intravenous infusion 3. Effectiveness and safety of polygeline in patients with. In the immediate postoperative period after moderate surgical procedures, 1 litre of a colloid solution or saline was given intravenously. Colloid osmotic pressure of plasma replacement fluids. A normovolemic hemodilution technique was used with hydroxyethyl starch n 6. A comparison of albumin, polygeline and crystalloid. Pdf hydroxyethyl starch should not be used to manage severe.
They also reported a 67% incidence of hyperchloremic. Anaphylactoid reaction to pentastarch springerlink. Hydroxyethyl starch heshaes is a nonionic starch derivative. Gelofusine which does not contain calcium has a greater effect on coagulation than haemaccel which contains 6. The problems of using unbuffered solutions during the perioperative period and comparison between restrictive versus liberal fluid management are discussed in full. Plasma expanders for people with cirrhosis and large ascites. Postoperative bleeding was quantified from the hourly chest drainage in the first 4 h and at 24 h postoperatively. The use of colloidal solutions proved preferable to the use of crystalloid solutions alone, as judged by oxygen debt, the volume required and the evidence of pulmonary overload.
Hydroxyethyl starch solutions and patient harm the lancet. Different types of hydroxyethyl starches are typically described by their average molecular weight, typically around to 200 kda bearing in mind that there will be a range of differentsized molecules in any given solution. Septic shock severe sepsis fluid resuscitation hydroxyethyl starch. Constant rate infusions cris of hydroxyethyl starch solutions of 1 to 2 mlkgh can be administered to increase oncotic pressure in stable, hypoproteinemic patients. Hydroxyethyl starch in isotonic sodium chloride intravenous infusion 6.
Plasma volume changes after infusion of various plasma. Hydroxyethyl starch has recently become the subject of renewed interest because of the introduction of a new specification, hydroxyethyl starch 0. Resuscitation fluids for the treatment of hemorrhagic. For albumin or plasma protein fraction ppf versus hydroxyethyl starch hes 31. The hydroxyethyl starch preparations include tetrastarch, hetastarch, and. Tot activity ranging from zero with hydroxyethyl starch to well above that of albumin with succinylated.
Histamine release was common in all three groups at 30 minutes 5078% and up to 4 hours late release reaction 6783% after the start of infusion. When compared to intravenous hydroxyethyl starches, using gelatin solutions was associated with a lower risk of acute renal failure or 0. The frequency of severe reactions shock, cardiac andor respiratory arrest was 0003% for plasmaprotein solutions, 0006% for hydroxyethyl starch, 0008% for dextran, and 0038% for gelatin. Succinylated gelatin is a 4% solution and does not contain calcium. The plasma volume expansion after infusion of dextran 70 macrodex, hydroxyet. In the in vitro experiment, the authors tested the hypothesis of a direct inhibition of mmp9 by the fluids used perioperatively, i. Pathophysiology and prevention of paracentesisinduced. Colloid fluids chapter 3 clinical fluid therapy in the. Following a closed head injury, an 18yrold male was admitted to the intensive care unit. Seven different hydroxyethyl starch hes solutions were measured, and the cop varied between half and 3 times that of normal human serum, depending on molecular weight and concentration of the. Benefits and risks of using gelatin solution as a plasma. Pdf hydroxyethyl starch should not be used to manage.
Table 1 volume of various solutions that is necessary to expand plasma volume hydrostatic. This article is an update of colloid solutions for fluid resuscitation. To report a probable anaphylactoid reaction to pentastarch, a low molecular weight hydroxyethyl starch hes colloid solution. Most hydroxyethyl starch solutions have a concentration of 6%. Influence of different strategies of volume replacement on. Gelatin succinate an overview sciencedirect topics. Inal mt, memis d, karamanlioglu b, sut n j crit care, 252. Low molecular weight 70 kda medium molecular weight 270 kda high molecular weight 450 kda. Resuscitation in haemorrhagic shockpulmonary and renal.
Annex i list of the names, pharmaceutical forms, strengths of. Albumin is considered the standard product against which no plasma expansion or other plasma expanders, e. Waitzinger j, bepperling f, pabst g, opitz j, muller m, baron jf 1998 pharmacokinetics and tolerability of a new hydroxyethyl starch hes specification hes 0. Colloid solutions in the critically ill stockwell 1992. Pdf comparison of hydroxyethyl starch and ringer lactate.
Hydroxyethyl starch heshaes, sold under the brand name voluven among others, is a nonionic starch derivative, used as a volume expander in intravenous therapy. Furthermore, hydroxyethyl starch solution may have other benefits e. The presence of heterogeneity was assessed by the i2 statistic and an i2 40% was taken as significant heterogeneity in this study. Perioperative fluid management ehab farag springer. The dilemma of perioperative use of hydroxyethyl starch solutions and the resurgence of interest in using human albumin as an alternative colloid is explored. Measurement and observation period was 240 min after the start of the. Plasma expanders for people with cirrhosis and large. The development of newer starch based plasma volume expanders has been driven by the need to improve safety and pharmacological properties while maintaining the volume efficacy of previous hes. Effects of polygeline and hydroxyethyl starch solutions on liver functions assessed with limon in hypovolemic patients j crit care. Hes is a general term and can be subclassified according to average molecular weight, molar substitution, concentration, c2c6 ratio and maximum daily dose. Evaluation of early and late histamine release by three. Hes are synthetic colloid solutions used as plasma volume expanders in a.
Prolonged itching related to intradermal deposition. Hemodynamic effects of 6% and 10% hydroxyethyl starch solutions versus 4% albumin solution in septic patients. This in vitro study was performed to assess whether calcium might be the cause of the different effects on coagulation. Normovolemic hemodilution technique was used with hydroxyethyl starch n 6, human albumin n 6 and polygeline n 9. In addition, human albumin solutions, plasmaprotein fraction, freshfrozen plasma ffp and immunoglobulin solutions are all human plasma derivatives that are colloid solutions. Plasma volume changes after infusion of various plasma expanders. Comparison of the effect of 6% hydroxyethyl starch and. Does calcium cause the different effects of gelofusine and. Christiane hartog and colleagues discuss the evidence and call on doctors to avoid using starch formulations concerns about serious side effects. Effects of polyethylene glycol and hydroxyethyl starch in. The aim of this study was to investigate the effects of fluid resuscitation with 3. Histamine release depends on the clinical scenario, concomitant drugs, infusion speed.
Anasthesiol intensivmed notfallmed schmerzther 1997. Priming solutions for cardiopulmonary bypass circuits. Following metaanalysis, the use of colloidal solutions in intensive care medicine is under discussion. Hydroxyethyl starches hes are synthetic colloids commonly used for fluid resuscitation to replace intravascular volume. Crystalloids versus colloids in the treatment of hypovolemic. Concerns over use of hydroxyethyl starch solutions the bmj. Albumin, dextran, gelatin, and hydroxyethyl starch hes solutions are colloids that efficiently expand the circulating blood volume. The remaining 22 trials assessed one type of plasma expander, i.
The three colloidal solutions studied, namely dextran 70, hydroxyethyl starch and haemaccel polygeline, produced. Sep 16, 2019 these solutions will hydrate cells, although their use may deplete fluid within the circulatory system. The weight average molecular weight is categorized into. We conclude that the four colloids tested, consisting of two gelatinbased fluids, another containing hydroxyethyl starch and another based on albumin, each cause a metabolic acidosis of near identical severity to that caused by saline on ex vivo haemodilution, despite weak acid a. Hydroxyethyl starch haessteril 6% 60 mgml solution for infusion intravenous use belgium baxter sa bd rene branquart, 80 7860 lessines belgium sodium acetate trihydrate, potassium chlorid, magnesium chlorid hexahydrate, sodium chlorid, calcium chlorid dihydrate, hydroxyethyl starch plasmavolume redibag 6% 3. An important aspect in the treatment of hemorrhagic shock is the reestablishment of normal myocardial blood flow after fluid resuscitation. In the first 12 hr after admission, he had received 2500. Fda warns of higher mortality risk with hydroxyethyl starch. The administration of colloids restores the intravascular volume with minimal risk of tissue edema in comparison with crystalloid solutions alone.
Mfg is 4% solution in normal saline, whereas ureabridged gelatin is a. Part of the yearbook of intensive care and emergency medicine book series yearbook. Volume replacement in the surgical patienta british journal of. Effect of hydroxyethyl starch solution on kidney function in surgical intensive care patients. Icp pharma inc 7360 bryan dairy road suite 225230,largo, florida 3377 usa. A comparison of albumin, polygeline and crystalloid priming. Nov 10, 2014 large trials have shown that hydroxyethyl starch increases the risk of death, kidney injury, and bleeding. University of wisconsin uw preservation solution is considered an effective flush and cold storage liquid. Resuscitation fluids for the treatment of hemorrhagic shock. Resuscitation in haemorrhagic shockpulmonary and renal effects. The three colloidal solutions studied, namely dextran 70, hydroxyethyl starch and haemaccel polygeline, produced very similar results.
Comparison of the effects of gelatin and a modern hydroxyethyl starch solution on renal function and inflammatory response in elderly cardiac surgery patients. Plasma volume expanders are used in connection to paracentesis in people with cirrhosis to prevent reduction of effective plasma volume, which may trigger deleterious effect on haemodynamic balance, and increase morbidity and mortality. Both succinylated gelatin and polygeline are supplied as preservativefree, sterile. Fortyfive patients received 6% hydroxyethyl starch 0. The two marketed solutions are haemaccel, which contains 3.
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