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Journal of Infusion Nursing : the... 2015Oxygen delivery capacity during profoundly anemic conditions depends on blood's oxygen-carrying capacity and cardiac output. Oxygen-carrying blood substitutes and blood... (Review)
Review
Oxygen delivery capacity during profoundly anemic conditions depends on blood's oxygen-carrying capacity and cardiac output. Oxygen-carrying blood substitutes and blood transfusion augment oxygen-carrying capacity, but both have given rise to safety concerns, and their efficacy remains unresolved. Anemia decreases oxygen-carrying capacity and blood viscosity. Present studies show that correcting the decrease of blood viscosity by increasing plasma viscosity with newly developed plasma expanders significantly improves tissue perfusion. These new plasma expanders promote tissue perfusion, increasing oxygen delivery capacity without increasing blood oxygen-carrying capacity, thus treating the effects of anemia while avoiding the transfusion of blood.
Topics: Anemia; Erythrocyte Transfusion; Hemorrhage; Humans; Oxygen; Plasma Substitutes
PubMed: 25871869
DOI: 10.1097/NAN.0000000000000103 -
Acta Anaesthesiologica Scandinavica Aug 2022Albumin for intravenous infusion is marketed in two concentrations, 20% and 5%, but how they compare with regard to plasma volume expansion over time is unclear. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Albumin for intravenous infusion is marketed in two concentrations, 20% and 5%, but how they compare with regard to plasma volume expansion over time is unclear.
METHODS
In a prospective crossover study, 12 volunteers received 3 ml kg of 20% albumin and, on another occasion, 12 ml kg of 5% albumin over 30 min. Hence, equivalent amounts of albumin were given. Blood was collected on 15 occasions over 6 h. Mass balance and volume kinetics were used to estimate the plasma volume expansion and the capillary leakage of albumin and fluid based on measurements of blood hemoglobin, plasma albumin, and the colloid osmotic pressure.
RESULTS
The greatest plasma volume expansion was 16.0 ± 6.4% (mean ± SD) with 20% albumin and 19.0 ± 5.2% with 5% albumin (p < .03). The volume expansion with 20% albumin corresponded to twice the infused volume. One third of the 5% albumin volume quickly leaked out of the plasma, probably because of the higher colloid osmotic pressure of the volunteer plasma (mean, 24.5 mmHg) than the albumin solution (19.1 mmHg). At 6 h, the capillary leakage amounted to 42 ± 15% and 47 ± 11% of the administered albumin with the 20% and 5% preparations, respectively (p = .28). The corresponding urine outputs were 547 (316-780) ml and 687 (626-1080) ml (median and interquartile range; p = .24).
CONCLUSION
The most important difference between the fluids was a dehydrating effect of 20% albumin when the same albumin mass was administered.
Topics: Colloids; Cross-Over Studies; Humans; Kinetics; Plasma Substitutes; Prospective Studies; Serum Albumin; Volunteers
PubMed: 35491239
DOI: 10.1111/aas.14074 -
Minerva Anestesiologica Oct 2011Over the last two decades, experimental and clinical data have begun to shape a more discriminating approach to intravascular (IV) fluid infusions in the resuscitation... (Review)
Review
Over the last two decades, experimental and clinical data have begun to shape a more discriminating approach to intravascular (IV) fluid infusions in the resuscitation of trauma patients with presumed internal hemorrhage. This approach takes into account the presence of potentially uncontrollable hemorrhage (e.g., deep intra-abdominal or intra-thoracic injury) versus a controllable source (e.g. distal extremity wound). This limitation on fluid resuscitation is particularly applicable in the case of patients with penetrating truncal injury being transported rapidly to a nearby definitive care center. Meanwhile, longstanding debates over the type of fluid that should be infused remain largely unresolved and further complicated by recent clinical trials that did not demonstrate support for either hemoglobin-based oxygen carriers or hypertonic saline. However, there is also growing evidence that does support the increased use of fresh frozen plasma as well as tourniquets, and intra-osseous devices. While a more discriminating approach to fluid infusions have evolved, it has also become clear that positive pressure ventilatory support should be limited in the face of potential severe hemorrhage due to the accompanying reductions in venous return. Controversies over prehospital endotracheal tube placement are confounded by this factor as well as the effects of paramedic deployment strategies and related skills usage. Beyond these traditional areas of focus, a number of very compelling clinical observations and an extensive body of experimental data has generated a very persuasive argument that intravenous estrogen and progesterone may be of value in trauma management, particularly severe traumatic brain injury and burns.
Topics: Blood Volume; Catheters, Indwelling; Fluid Therapy; Gonadal Steroid Hormones; Hemostasis; Humans; Plasma Substitutes; Positive-Pressure Respiration; Resuscitation; Wounds and Injuries; Wounds, Nonpenetrating; Wounds, Penetrating
PubMed: 21952600
DOI: No ID Found -
CNS Drugs Nov 2017Cardiovascular autonomic dysfunctions, including neurogenic orthostatic hypotension, supine hypertension and post-prandial hypotension, are relatively common in patients... (Review)
Review
Cardiovascular autonomic dysfunctions, including neurogenic orthostatic hypotension, supine hypertension and post-prandial hypotension, are relatively common in patients with Parkinson disease. Recent evidence suggests that early autonomic impairment such as cardiac autonomic denervation and even neurogenic orthostatic hypotension occur prior to the appearance of the typical motor deficits associated with the disease. When neurogenic orthostatic hypotension develops, patients with Parkinson disease have an increased risk of mortality, falls, and trauma-related to falls. Neurogenic orthostatic hypotension reduces quality of life and contributes to cognitive decline and physical deconditioning. The co-existence of supine hypertension complicates the treatment of neurogenic orthostatic hypotension because it involves the use of drugs with opposing effects. Furthermore, treatment of neurogenic orthostatic hypotension is challenging because of few therapeutic options; in the past 20 years, the US Food and Drug Administration approved only two drugs for the treatment of this condition. Small, open-label or randomized studies using acute doses of different pharmacologic probes suggest benefit of other drugs as well, which could be used in individual patients under close monitoring. This review describes the pathophysiology of neurogenic orthostatic hypotension and supine hypertension in Parkinson disease. We discuss the mode of action and therapeutic efficacy of different pharmacologic agents used in the treatment of patients with cardiovascular autonomic failure.
Topics: Accidental Falls; Adrenergic alpha-1 Receptor Agonists; Drug Administration Schedule; Humans; Hypertension; Hypotension, Orthostatic; Parkinson Disease; Plasma Substitutes; Supine Position; Vasoconstrictor Agents; Vasodilator Agents
PubMed: 29076058
DOI: 10.1007/s40263-017-0473-5 -
Intensive Care Medicine Feb 2015
Topics: Blood Pressure; Cardiac Output; Female; Fluid Therapy; Hemodynamics; Humans; Male; Plasma Substitutes
PubMed: 25649527
DOI: 10.1007/s00134-014-3637-5 -
Minerva Anestesiologica Jul 2011
Topics: Animals; Heart; Male; Plasma Substitutes; Serum Albumin
PubMed: 21709656
DOI: No ID Found -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Jul 2009We aimed to compare different fluids indicated in volume replacement in multiple trauma patients, enlightening the indications, mechanisms of action and side effects. An... (Review)
Review
We aimed to compare different fluids indicated in volume replacement in multiple trauma patients, enlightening the indications, mechanisms of action and side effects. An extensive review of references (indexed journals) between 1997 and 2008 was performed. There is not yet a consensus about which fluids should be used in trauma patients. The systematic reviews available did not show a benefit of colloid solutions over crystalloid fluids. Crystalloids intensify physiological internal dilution, furthered by water migration from interstitial and intracellular spaces into intravascular space due to hypovolemia. The most recent hypertonic solutions used in resuscitation have a large role in expanding blood volume and making blood pressure rise. The hyperoncotic effect of dextran solution produces an initial expansion of intravascular volume that is bigger than the administered volume. Gelatins are no longer used in developed countries due to their insignificant ability regarding volume expansion when compared to crystalloids and the potential risks of anaphylactic reactions. The crystalloids are used more in trauma, even if some authors prefer the use of colloids, which can produce a quicker restoration of the intravascular volume. No convincing evidence shows a clear superiority of colloids over crystalloids for restoration of the volume depletion.
Topics: Body Water; Colloids; Fluid Therapy; Hemostasis; Humans; Multiple Trauma; Plasma Substitutes; Plasma Volume; Rehydration Solutions; Resuscitation; Shock, Hemorrhagic
PubMed: 19669957
DOI: No ID Found -
Military Medical Research Nov 2020Plasma expanders are widely used for acute normovolemic hemodilution (ANH). However, existing studies have not focused on large-volume infusion with colloidal plasma...
BACKGROUND
Plasma expanders are widely used for acute normovolemic hemodilution (ANH). However, existing studies have not focused on large-volume infusion with colloidal plasma expanders, and there is a lack of studies that compare the effects of different plasma expanders.
METHODS
The viscosity, hydrodynamic radius (R) and colloid osmotic pressure (COP) of plasma expanders were determined by a cone-plate viscometer, Zetasizer and cut-off membrane, respectively. Sixty male rats were randomized into five groups with Gelofusine (Gel), Hydroxyethyl Starch 200/0.5 (HES200), Hydroxyethyl Starch 130/0.4 (HES130), Hydroxyethyl Starch 40 (HES40), and Dextran40 (Dex40), with 12 rats used in each group to build the ANH model. ANH was performed by the withdrawal of blood and simultaneous infusion of plasma expanders. Acid-base, lactate, blood gas and physiological parameters were detected.
RESULTS
Gel had a lower intrinsic viscosity than HES200 and HES130 (P < 0.01), but at a low shear rate in a mixture of colloids, red cells and plasma, Gel had a higher viscosity (P < 0.05 or P < 0.01, respectively). For hydroxyethyl starch plasma expanders, the COP at a certain concentration decreases from 11.1 mmHg to 6.1 mmHg with the increase of R from 10.7 nm to 20.2 nm. A severe ANH model, with the hematocrit of 40% of the baseline level, was established and accompanied by disturbances in acid-base, lactate and blood gas parameters. At the end of ANH and 60 min afterward, the Dex40 group showed a worse outcome in maintaining the acid-base balance and systemic oxygenation compared to the other groups. The systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) decreased significantly in all groups at the end of ANH. The DBP and MAP in the Dex40 group further decreased 60 min after the end of ANH. During the process of ANH, the Dex40 group showed a drop and recovery in SBP, DBP and MAP. The DBP and MAP in the HES200 group were significantly higher than those in the other groups at some time points (P < 0.05 or P < 0.01).
CONCLUSION
Gel had a low intrinsic viscosity but may increase the whole blood viscosity at low shear rates. R and COP showed a strong correlation among hydroxyethyl starch plasma expanders. Dex40 showed a worse outcome in maintaining the acid-base balance and systemic oxygenation compared to the other plasma expanders. During the process of ANH, Dex40 displayed a V-shaped recovery pattern for blood pressure, and HES200 had the advantage in sustaining the DBP and MAP at some time points.
Topics: Animals; Disease Models, Animal; Hemodilution; Plasma Substitutes; Rats
PubMed: 33172500
DOI: 10.1186/s40779-020-00282-4 -
Intensive Care Medicine Oct 2017
Topics: Acute Kidney Injury; Crystalloid Solutions; Fluid Therapy; Humans; Hydroxyethyl Starch Derivatives; Hypovolemia; Intensive Care Units; Isotonic Solutions; Plasma Substitutes; Randomized Controlled Trials as Topic; Sepsis; Severity of Illness Index
PubMed: 27007101
DOI: 10.1007/s00134-016-4275-x -
Brazilian Journal of Anesthesiology... 2023
Topics: Humans; Hydroxyethyl Starch Derivatives; Plasma Substitutes; Fluid Therapy
PubMed: 37442431
DOI: 10.1016/j.bjane.2023.07.004