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Critical Care (London, England) 2008Small-volume resuscitation can rapidly correct hypovolemia. Hyperoncotic albumin solutions, long in clinical use, are suitable for small-volume resuscitation; however,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Small-volume resuscitation can rapidly correct hypovolemia. Hyperoncotic albumin solutions, long in clinical use, are suitable for small-volume resuscitation; however, their clinical benefits remain uncertain.
METHODS
Randomized clinical trials comparing hyperoncotic albumin with a control regimen for volume expansion were sought by multiple methods, including computer searches of bibliographic databases, perusal of reference lists, and manual searching. Major findings were qualitatively summarized. In addition, a quantitative meta-analysis was performed on available survival data.
RESULTS
In all, 25 randomized clinical trials with a total of 1,485 patients were included. In surgery, hyperoncotic albumin preserved renal function and reduced intestinal edema compared with control fluids. In trauma and sepsis, cardiac index and oxygenation were higher after administration of hydroxyethyl starch than hyperoncotic albumin. Improved treatment response and renal function, shorter hospital stay and lower costs of care were reported in patients with liver disease receiving hyperoncotic albumin. Edema and morbidity were decreased in high-risk neonates after hyperoncotic albumin administration. Disability was reduced by therapy with hyperoncotic albumin in brain injury. There was no evidence of deleterious effects attributable to hyperoncotic albumin. Survival was unaffected by hyperoncotic albumin (pooled relative risk, 0.95; 95% confidence interval 0.78 to 1.17).
CONCLUSION
In some clinical indications, randomized trial evidence has suggested certain benefits of hyperoncotic albumin such as reductions in morbidity, renal impairment and edema. However, further clinical trials are needed, particularly in surgery, trauma and sepsis.
Topics: Albumins; Edema; Humans; Hypovolemia; Plasma Substitutes; Randomized Controlled Trials as Topic; Resuscitation; Solutions
PubMed: 18318896
DOI: 10.1186/cc6812 -
Clinical Journal of the American... Mar 2008The monitoring of physiologic variables is an integral part of the diagnosis and management of the critically ill patient. Restoration of tissue perfusion and oxygen... (Review)
Review
The monitoring of physiologic variables is an integral part of the diagnosis and management of the critically ill patient. Restoration of tissue perfusion and oxygen delivery is the ultimate goal for any state of circulatory collapse. Insight into a patient's intravascular volume status and cardiac performance, particularly in the early stages of shock, can help guide management and potentially change outcome. In the past 30 years, various bedside monitoring techniques and indices have been developed in an effort to determine and optimize a patient's cardiac performance. This article reviews the physiologic parameters that best predict intravascular volume status and volume responsiveness. We examine the controversies surrounding the pulmonary arterial catheter and describe the less invasive methods of measuring cardiac performance.
Topics: Critical Care; Hemodynamics; Humans; Monitoring, Physiologic; Nephrology; Plasma Substitutes
PubMed: 18256382
DOI: 10.2215/CJN.01440307 -
Nefrologia : Publicacion Oficial de La... 2017Normal saline has traditionally been the resuscitation fluid of choice in the perioperative period of kidney transplantation over balanced potassium solutions. However,... (Review)
Review
Normal saline has traditionally been the resuscitation fluid of choice in the perioperative period of kidney transplantation over balanced potassium solutions. However, the problems arising from hyperchloraemia triggered by the infusion of normal saline have led to studies being conducted that compare this solution with balanced solutions. From this narrative review it can be concluded that the use of balanced crystalloids containing potassium in the perioperative period of kidney transplantation can be considered safe. These solutions do not affect serum potassium levels any more than normal saline, whilst maintaining a better acid-base balance in these patients.
Topics: Acid-Base Equilibrium; Acid-Base Imbalance; Blood Volume; Chlorides; Colloids; Crystalloid Solutions; Diuresis; Double-Blind Method; Fluid Therapy; Humans; Intraoperative Complications; Isotonic Solutions; Kidney Transplantation; Osmolar Concentration; Perioperative Care; Plasma Substitutes; Postoperative Complications; Potassium; Randomized Controlled Trials as Topic; Sodium Chloride; Solutions
PubMed: 29122209
DOI: 10.1016/j.nefro.2017.03.022 -
Medicina (Kaunas, Lithuania) 2005Hypovolemia is common among surgical, trauma, and intensive care unit patients. It can occur in the absence of obvious fluid loss secondary to vasodilatation or during... (Review)
Review
Hypovolemia is common among surgical, trauma, and intensive care unit patients. It can occur in the absence of obvious fluid loss secondary to vasodilatation or during generalized alterations of the endothelial barrier resulting in increased capillary permeability. Hydroxyethyl starch solutions are increasingly used for the volume replacement therapy. Hydroxyethyl starch solutions are synthetic colloids with the pharmacological properties that are the closest to natural colloids. Important characteristics for these products are molecular weight, their concentration, the degree of molar substitution, and the substitution pattern. In this review article a large variety of hydroxyethyl starch solutions, their physical and chemical characteristics, pharmacokinetics and metabolism, the main route of elimination, mechanism of action, effect on blood plasma volume, safety, tolerability and side effects (the risk of adverse effects on hemostasis, platelet function, frequency of pruritus, anaphylactoid reaction, incidence of rise in serum amylase) are presented.
Topics: Colloids; Contraindications; Drug Interactions; Humans; Hydroxyethyl Starch Derivatives; Hypovolemia; Molecular Weight; Plasma Substitutes; Retrospective Studies; Safety; Solutions
PubMed: 15947530
DOI: No ID Found -
Critical Care (London, England) May 2019Optimal infusion rate of colloids in patients with suspected hypovolemia is unknown, and the primary objective of the present study was to test if plasma volume... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Optimal infusion rate of colloids in patients with suspected hypovolemia is unknown, and the primary objective of the present study was to test if plasma volume expansion by 5% albumin is greater if fluid is administered slowly rather than rapidly.
METHODS
Patients with signs of hypoperfusion after major abdominal surgery were randomized to intravenous infusion of 5% albumin at a dose of 10 ml/kg (ideal body weight) either rapidly (30 min) or slowly (180 min). Plasma volume was measured using radiolabeled albumin at baseline, at 30 min, and at 180 min after the start of infusion. Primary outcome was change in plasma volume from the start of infusion to 180 min after the start of infusion. Secondary outcomes included the change in the area under the plasma volume curve and transcapillary escape rate (TER) for albumin from 180 to 240 min after the start of albumin infusion.
RESULTS
A total of 33 and 31 patients were included in the analysis in the slow and rapid groups, respectively. The change in plasma volume from the start of infusion to 180 min did not differ between the slow and rapid infusion groups (7.4 ± 2.6 vs. 6.5 ± 4.1 ml/kg; absolute difference, 0.9 ml/kg [95%CI, - 0.8 to 2.6], P = 0.301). Change in the area under the plasma volume curve was smaller in the slow than in the rapid infusion group and was 866 ± 341 and 1226 ± 419 min ml/kg, respectively, P < 0.001. TER for albumin did not differ and was 5.3 ± 3.1%/h and 5.4 ± 3%/h in the slow and in the rapid infusion groups, respectively, P = 0.931.
CONCLUSIONS
This study does not support our hypothesis that a slow infusion of colloid results in a greater plasma volume expansion than a rapid infusion. Instead, our result of a smaller change in the area under the plasma volume curve indicates that a slow infusion results in a less efficient plasma volume expansion, but further studies are required to confirm this finding. A rapid infusion has no effect on vascular leak as measured after completion of the infusion.
TRIAL REGISTRATION
EudraCT2013-004446-42 registered December 23, 2014.
Topics: Aged; Albumins; Analysis of Variance; Digestive System Surgical Procedures; Female; Gynecologic Surgical Procedures; Humans; Infusions, Intravenous; Male; Middle Aged; Plasma Substitutes; Plasma Volume; Postoperative Complications; Prospective Studies; Statistics, Nonparametric; Sweden
PubMed: 31138247
DOI: 10.1186/s13054-019-2477-7 -
Anaesthesiology Intensive Therapy 2014This review summarises the new insights into the physiology of perioperative fluid therapy and analyses recent studies of the safety of the use of HES solutions in the... (Review)
Review
This review summarises the new insights into the physiology of perioperative fluid therapy and analyses recent studies of the safety of the use of HES solutions in the fluid management of critically ill patients. This analysis reveals a number of methodological issues in the three major studies that have initiated the recommendation of the European Medicine Agency to ban hydroxyethyl starches from clinical practice. It is concluded that, when used in the proper indication, and taking into account the recommended doses, hydroxyethyl starches continue to have a place in perioperative fluid management.
Topics: Fluid Therapy; Humans; Hydroxyethyl Starch Derivatives; Intraoperative Care; Operating Rooms; Plasma Substitutes; Water-Electrolyte Balance
PubMed: 25432553
DOI: 10.5603/AIT.2014.0057 -
Canadian Journal of Surgery. Journal... Jun 2007Hemorrhagic shock is a leading cause of death in trauma patients. Surgical control of bleeding and fluid resuscitation with both crystalloid and blood products remain... (Review)
Review
Hemorrhagic shock is a leading cause of death in trauma patients. Surgical control of bleeding and fluid resuscitation with both crystalloid and blood products remain the mainstay of therapy for injured patients with bleeding. However, there has been a recent re-evaluation of transfusion practice. Both the fear of transmissible disease and the costs of transfusing blood products have led to increasingly restrictive transfusion practices. A small percentage of trauma patients require massive transfusion. These patients are complex and difficult to manage, and clinicians must act quickly to save them. There is little evidence to help guide clinical transfusion decisions in these patients. A rational approach to using blood products requires an understanding of the end points of resuscitation. Resuscitation with fluids and red cells is necessary to improve perfusion and oxygen delivery to tissues. Avoiding overtransfusion is key, however, because transfusion is also associated with significant risks. This trend toward reducing allogenic blood exposure will likely continue. New technologies that have the potential of reducing blood loss and transfusion requirements in trauma patients with massive bleeding are being developed, and similar old technologies are being reapplied.
Topics: Factor VII; Factor VIIa; Fibrin Tissue Adhesive; Hemorrhage; Hemostatics; Humans; Isotonic Solutions; Plasma Substitutes; Recombinant Proteins; Resuscitation; Thrombelastography; Transfusion Reaction; Wounds and Injuries
PubMed: 17568492
DOI: No ID Found -
BMJ (Clinical Research Ed.) Mar 2003
Topics: Albumins; Australia; Critical Illness; Crystalloid Solutions; Fluid Therapy; Humans; Isotonic Solutions; Meta-Analysis as Topic; New Zealand; Plasma Substitutes
PubMed: 12637372
DOI: 10.1136/bmj.326.7389.559 -
Lakartidningen May 2018
Topics: Colloids; Fluid Therapy; Humans; Hydroxyethyl Starch Derivatives; Legislation, Drug; Plasma Substitutes; Sepsis
PubMed: 29738050
DOI: No ID Found -
Anaesthesia Nov 1986
Topics: Aged; Erythrocyte Transfusion; Erythrocytes; Humans; Male; Plasma Substitutes; Transfusion Reaction
PubMed: 3789385
DOI: 10.1111/j.1365-2044.1986.tb12990.x