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Critical Care (London, England) Mar 2020This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2020. Other selected articles can be found online at... (Review)
Review
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2020. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2020. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.
Topics: Cardiovascular Physiological Phenomena; Emergency Medicine; Humans; Plasma Substitutes; Resuscitation; Sepsis
PubMed: 32204718
DOI: 10.1186/s13054-020-2779-9 -
The Cochrane Database of Systematic... 2000Plasma volume is reduced amongst women with pre-eclampsia. This association has led to the suggestion that expanding the plasma volume might improve maternal and... (Review)
Review
BACKGROUND
Plasma volume is reduced amongst women with pre-eclampsia. This association has led to the suggestion that expanding the plasma volume might improve maternal and uteroplacental circulation, and so potentially improve outcome for both the woman and her baby.
OBJECTIVES
The aim of this review was to assess the effects of plasma volume expansion for the treatment of women with pre-eclampsia.
SEARCH STRATEGY
The register of trials maintained by the Cochrane Pregnancy and Childbirth Group, and the Cochrane Controlled Trials Register Issue 1 1999 were searched for trials meeting the selection criteria.
SELECTION CRITERIA
Randomised trials were included. Quasi-random designs were excluded. Participants were women with hypertension during pregnancy, with or without proteinuria. Women who were postpartum at trial entry were excluded. Interventions were any comparison of plasma volume expansion with no expansion, or of one plasma volume expander with another.
DATA COLLECTION AND ANALYSIS
Data were extracted independently by two reviewers. Discrepancies were resolved by discussion. There was no blinding of authorship or results.
MAIN RESULTS
Three trials involving 61 women were included in this review. All compared a colloid solution with no plasma volume expansion. For every outcome reported, the confidence intervals are very wide and cross the no effect line.
REVIEWER'S CONCLUSIONS
There is insufficient evidence for any reliable estimates of the effects of plasma volume expansion for women with pre-eclampsia.
Topics: Female; Humans; Plasma Substitutes; Pre-Eclampsia; Pregnancy
PubMed: 10796272
DOI: 10.1002/14651858.CD001805 -
Intensive Care Medicine Feb 2014To systematically review clinical and preclinical data on hydroxyethyl starch (HES) tissue storage. (Review)
Review
PURPOSE
To systematically review clinical and preclinical data on hydroxyethyl starch (HES) tissue storage.
METHODS
MEDLINE (PubMed) was searched and abstracts were screened using defined criteria to identify articles containing original data on HES tissue accumulation.
RESULTS
Forty-eight studies were included: 37 human studies with a total of 635 patients and 11 animal studies. The most frequent indication for fluid infusion was surgery accounting for 282 patients (45.9%). HES localization in skin was shown by 17 studies, in kidney by 12, in liver by 8, and in bone marrow by 5. Additional sites of HES deposition were lymph nodes, spleen, lung, pancreas, intestine, muscle, trophoblast, and placental stroma. Among major organs the highest measured tissue concentration of HES was in the kidney. HES uptake into intracellular vacuoles was observed by 30 min after infusion. Storage was cumulative, increasing in proportion to dose, although in 15% of patients storage and associated symptoms were demonstrated at the lowest cumulative doses (0.4 g kg(-1)). Some HES deposits were extremely long-lasting, persisting for 8 years or more in skin and 10 years in kidney. Pruritus associated with HES storage was described in 17 studies and renal dysfunction in ten studies. In one included randomized trial, HES infusion produced osmotic nephrosis-like lesions indicative of HES storage (p = 0.01) and also increased the need for renal replacement therapy (odds ratio, 9.50; 95% confidence interval, 1.09-82.7; p = 0.02). The tissue distribution of HES was generally similar in animals and humans.
CONCLUSIONS
Tissue storage of HES is widespread, rapid, cumulative, frequently long-lasting, and potentially harmful.
Topics: Animals; Humans; Hydroxyethyl Starch Derivatives; Plasma Substitutes; Tissue Distribution
PubMed: 24257970
DOI: 10.1007/s00134-013-3156-9 -
Academic Emergency Medicine : Official... 1994
Comparative Study
Topics: Colloids; Crystalloid Solutions; Humans; Isotonic Solutions; Plasma Substitutes; Resuscitation
PubMed: 7600395
DOI: 10.1111/j.1553-2712.1994.tb02541.x -
Anesthesiology Sep 2012
Topics: Humans; Hydroxyethyl Starch Derivatives; Male; Middle Aged; Nephrosis; Plasma Substitutes
PubMed: 22370625
DOI: 10.1097/ALN.0b013e31824de9ad -
Minerva Anestesiologica Oct 2016Fluid therapy is considered a cornerstone of perioperative and critical care medicine. However, the type of fluids used varies widely among different countries.... (Review)
Review
Fluid therapy is considered a cornerstone of perioperative and critical care medicine. However, the type of fluids used varies widely among different countries. Synthetic colloids may negatively affect coagulation and are potentially nephrotoxic. "Modern" hydroxyethyl starches (HES) were widely used until recently when their association to mortality and renal replacement therapy risk among critically ill patients brought to restriction by the European Medicines Agency in 2013. Since synthetic colloids are traditionally thought to be much more effective as volume expanders than crystalloids (although their efficacy is probably largely overrated), there is concern that physicians, practically deprived of HES, could be tempted to rely again on "old" gelatins. The aim of this contribution is to warn clinicians that gelatins share all potential adverse effects of other synthetic colloids, and are possibly even more nephrotoxic than HES. Moreover, gelatins have no beneficial effects on outcomes as compared with crystalloids (on the contrary, they might even increase mortality), and are also more expensive. Accordingly, a "return" to gelatins should be strongly discouraged.
Topics: Colloids; Critical Illness; Fluid Therapy; Gelatin; Humans; Hydroxyethyl Starch Derivatives; Medical Errors; Plasma Substitutes
PubMed: 27045639
DOI: No ID Found -
Archives of Disease in Childhood. Fetal... Jan 2006Several studies have shown the efficacy of dilutional exchange transfusion (DET) in reducing haematocrit (Ht) and relieving clinical symptoms in neonatal polycythaemia.... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Several studies have shown the efficacy of dilutional exchange transfusion (DET) in reducing haematocrit (Ht) and relieving clinical symptoms in neonatal polycythaemia. We conducted a systematic review to determine the efficacy of crystalloid versus colloid solutions used in DET in an effort to identify the best solution to replace red blood cells.
METHODS
The Cochrane Library, MEDLINE, and EMBASE were searched for relevant randomised controlled trials. Quality assessment and data analysis were performed using the methods and software of the Cochrane Collaboration. Relative risk (RR) and weighted mean difference (WMD) were calculated as measures of effect for categorical and continuous outcome data, respectively. Ninety five percent confidence intervals (95% CI) were calculated and a fixed effect model was used for meta-analysis.
RESULTS
Six studies with a total of 235 newborns matched our inclusion criteria. When comparing crystalloid and colloid replacement solutions for DET, there was a clinically unimportant difference in Ht at 2-6 h and at 24 h in favour of colloidal solutions (WMD 2.29% (95% CI 1.28 to 3.31) and 1.74% (95% CI 0.80 to 2.68), respectively). This difference in post DET Ht was more evident when normal saline was compared to plasma but absent when normal saline was compared to 5% albumin.
CONCLUSION
There is little difference in effectiveness between plasma, 5% albumin, and crystalloid solutions. Since normal saline is cheap, readily available, and does not carry the potential risk of transfusion associated infection, normal saline is the optimal dilutional fluid for exchange transfusion in polycythaemic neonates.
Topics: Crystalloid Solutions; Exchange Transfusion, Whole Blood; Hematocrit; Humans; Infant, Newborn; Isotonic Solutions; Plasma Substitutes; Polycythemia; Randomized Controlled Trials as Topic; Rehydration Solutions
PubMed: 16371393
DOI: 10.1136/adc.2004.063925 -
Blood Transfusion = Trasfusione Del... Sep 2013
Review
Topics: Crystalloid Solutions; Humans; Isotonic Solutions; Italy; Plasma Substitutes; Serum Albumin
PubMed: 24333310
DOI: 10.2450/2013.006s -
The Cochrane Database of Systematic... Oct 2004Secondary ischaemia is a frequent complication after aneurysmal subarachnoid haemorrhage (SAH), and responsible for a substantial proportion of patients with poor... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Secondary ischaemia is a frequent complication after aneurysmal subarachnoid haemorrhage (SAH), and responsible for a substantial proportion of patients with poor outcome after SAH. The cause of secondary ischaemia is unknown, but hypovolaemia and fluid restriction are important risk factors. Therefore, volume expansion therapy (hypervolaemia) is frequently used in patients with SAH to prevent or treat secondary ischaemia.
OBJECTIVES
To determine the effectiveness of volume expansion therapy for improving outcome in patients with aneurysmal SAH.
SEARCH STRATEGY
We searched the Cochrane Stroke Group Trials Register (last searched September 2003). In addition we searched MEDLINE (1966 to January 2004) and EMBASE (1980 to January 2004) and contacted trialists to identify further published and unpublished studies.
SELECTION CRITERIA
All randomised controlled trials of volume expansion therapy in patients with aneurysmal SAH. We also sought controlled trials based on consecutive groups of patients quasi-randomly allocated to treatment or control group and included these in the analysis if the two groups were well comparable with regard to major prognostic factors.
DATA COLLECTION AND ANALYSIS
Two reviewers independently extracted the data and assessed trial quality. Trialists were contacted to obtain missing information.
MAIN RESULTS
We identified three trials. One truly randomised trial and one quasi-randomised trial with comparable baseline characteristics for both groups were included in the analyses. Volume expansion therapy did not improve outcome (Relative Risk (RR) 1.0; 95% Confidence Interval (CI) 0.5 to 2.2), nor the occurrence of secondary ischaemia (RR 1.1; 95% CI 0.5 to 2.2). Hypervolaemia tended to increase the rate of complications (RR 1.8; 95% CI 0.9 to 3.7) In another quasi-randomised trial, outcome assessment was done only at the day of operation (7 to 10 days after SAH). In the period before operation, treatment resulted in a reduction of secondary ischaemia (RR 0.33; 95% CI 0.11 to 0.99) and case fatality (RR 0.20; 95% CI 0.07 to 1.2).
REVIEWERS' CONCLUSIONS
The effects of volume expansion therapy have been studied properly in only two trials of patients with aneurysmal SAH, with very small numbers. At present, there is no sound evidence for the use of volume expansion therapy in patients with aneurysmal SAH.
Topics: Humans; Intracranial Aneurysm; Plasma Substitutes; Randomized Controlled Trials as Topic; Subarachnoid Hemorrhage
PubMed: 15494997
DOI: 10.1002/14651858.CD000483.pub2 -
Critical Care (London, England) Oct 2013The choice of which intravenous solution to prescribe remains a matter of considerable debate in intensive care units around the world. Trends have been moving away from... (Review)
Review
The choice of which intravenous solution to prescribe remains a matter of considerable debate in intensive care units around the world. Trends have been moving away from using hydroxyethyl starch solutions following concerns about safety. But are the available data sufficient to clearly assess the risk-benefit balance for all patients, and is there enough evidence of harm to justify removing these drugs completely from our hospitals?
Topics: Drug Labeling; Fluid Therapy; Humans; Hydroxyethyl Starch Derivatives; Plasma Substitutes; Risk Factors
PubMed: 24083341
DOI: 10.1186/cc13027