Plasma volume expanders: classification and characteristics of colloids

Fluid therapy remains an important therapeutic maneuver in managing surgical, medical, and the critically ill intensive care patient. However, the ideal volume replacement strategy remains under debate. The debate on whether patients should be managed with crystalloids, colloids, or both has for many years been mainly a debate about effectiveness. The dispute over crystalloids versus colloids has been enlarged to a colloid versus colloid debate because of the varying properties of different colloids. The natural colloid albumin and artificial colloids such as gelatin, dextran, and hydroxyethyl starch continue to enjoy widespread usage for clinical fluid management. Colloid is an effective plasma volume expander and is able to restore the hemodynamic profile with less total volume than crystalloid. However, colloid is associated with coagulation abnormalities, renal impairment, and allergic reactions. Albumin is considered to be one of the safe colloids. However, due to its cost, albumin cannot be recommended for hypovolemia. Gelatin and dextran can also cause coagulation abnormalities and renal impairment. Dextran is not used anymore due to its high anaphylactic potency. Each hydroxyethyl starch has different properties by concentration, mean molecular weight, molar substitution, and its C2/C6 ratio. New hydroxyethyl starches with a lower mean molecular weight and molar substitution than the old hydroxyethyl starch may be promising by improving volume management therapy with lower risks of coagulation abnormalities and renal impairment. The selection of colloid for plasma volume expansion should be based on the patients' clinical conditions and the characteristics of each colloid.

Effect of acute progressive normovolemic hemodilution with lactated Ringer's,gela-tin and hydroxyethyl starch on coagulation and survival rate in rabbits / 北京大学学报(医学版)

0.05),the average survival time of HES solutions was longer than that after LR or GEL infusion(t=3.012,P

Sustitutos de la sangre / Blood substitutes

Los sustitutos de la sangre, muchos de ellos aún en desarrollo, pueden constituir en un futuro no muy lejano un importante medio terapéutico, capaz de sustituir el empleo de componentes de la sangre alogénica, lo que evadiría los riesgos que el empleo de estos entraña. Entre ellos se encuentran sustitutos de los eritrocitos, de las plaquetas y del plasma, obtenidos a partir de sangre humana, de animales transgénicos o por tecnología recombinante. En el presente trabajo se hace una breve descripción de cada uno de ellos y el estadio de desarrollo y aplicación clínica en que se encuentran. No se abordan en esta revisión los factores de crecimiento, también útiles al estimular el crecimiento y diferenciación de células hematopoyéticas.

Blood substitutes, many of them still under development, may be in a near future an important therapeutic tool capable of substituting the use of allogeneic blood components, which will avoid the risk of using them. Among these blood substitutes, there are red cell, platelet and plasma substitutes obtained from human blood, blood of transgenic animals or by recombinant technology. A brief description of each of them and of the stage of development and clinical application in which they are is made. The growth factors, which are also useful on stimulating the growth and differentiation of hematopoietic cells are not approached in this review.

The Effects of Acute Hypervolemic Hemodilution on Hemorheology / 中国医师杂志

Objective To observe the changes of hemorheology after acute hypervolemic hemodilution (AHH), and provide theoretic basis for clinical rationally using artificial plasma substitutes. Methods 90 patients undergoing hip joint operation were randomly divided into 3 groups (each group containing 30 patients), which received intravenous infusion of 6% hydroxyethyl starch (HES), 4% gelofusine or ringer's solution at 20ml/kg, respectively before operation. The whole blood viscosity, plasma viscosity, Hct, index of RBC aggregation and index of RBC deformation were measured before and after hemodilution. Resutls Hemodynamics was stable after AHH, and the amounts of perioperatively blood transfusion in the patients received colloid solution were obviously less than those in the patients received crystalloid solution. The whole blood viscosity, Hct and index of RBC aggregation significantly decreased after AHH in all the patients, and index of RBC deformation markedly increased in the patients after AHH with 6% HES. Conclusion AHH could effectively maintain hemodynamics stable, improve hemorheological condition and perfusion of microcirculation, enhance the tolerance of blood loss, and reduce homologous blood transfusion. Colloid solution was better than crystalloid solution for AHH.

The safety of volume replacement with HAES 130/0.4 during non-cardiac surgery / 中华麻醉学杂志

Objective To evaluate the safety of plasma volume replacement with HAES 130/0.4 during non-cardiac surgery in terms of hemodynamic stability, blood gases, hepato-renal function, blood coagulation and adverse reactions. Methods This was a five center prospective study comparing the safety and efficacy of HAES 130/0.4(6%) with HAES 200/0.5(6%)in a double-blind fashion. The selection criteria included ASA Ⅰ Ⅱ patients of both sex, aged 18-65yrs undergoing non-cardiac surgery of which the intraoperative blood loss was expected to exceed 400ml. Patients whose Hb