A Comparison of 10% Pentastarch and 5% Albumin in Patients Undergoing Open‐Heart Surgery

Abstract

Colloids are useful in cardiac surgery to increase preload and improve cardiac output without the risks associated with blood transfusions. Pentastarch is a new low-molecular weight hydroxyethyl starch compound under investigation for this purpose. The authors compared, in a randomized fashion, 12 patients who received pentastarch and 17 patients who received albumin for volume expansion after open-heart surgery. During the 24-hour study period there was no significant difference between the two groups with respect to systemic blood pressure, mean arterial pressure, cardiac index, right atrial pressure, and pulmonary capillary wedge pressure, with the exception of a higher mean arterial pressure and systolic blood pressure at 4 hours in the albumin group and higher heart rate at 12 hours in the pentastarch group. In addition, postoperative prothrombin time, partial thromboplastin time, fibrinogen, platelets, and factor VIII levels were not significantly different between the two groups. There were no complications attributed to colloid administration. The hemodynamic parameters were further evaluated in a subset of 6 pentastarch and 9 albumin patients who received the first 500 mL of colloid in a similar time frame and under similar clinical conditions. The patients who received pentastarch showed a significantly greater increase in cardiac index than did the patients who received albumin. No significant change in other parameters were noted between the two groups. The authors conclude that pentastarch is as safe as albumin and may be a more effective volume expander than albumin when used in open-heart surgery patients.

Guidelines for the clinical use of albumin: comparison of use in two Italian hospitals and a third hospital without guidelines

“…Nonprotein colloids may be useful in reducing systemic edema. 7,14,15 Neonatal Hyperbilirubinemia Albumin should not be administered in conjunction with phototherapy or prior to exchange transfusion. Albumin has been used with mixed results as an adjuvant to exchange transfusion.…”

Hemorrhagic Shock Resuscitation with a Low Molecular Weight Starch Reduces Neutrophil-Endothelial Interactions and Vessel Leakage in vivo

“…Reports of bleeding abnormalities [12][13][14] and effects on renal function [15][16][17] by higher substituted HES and DEX have not been similarly reproduced in PTS, likely due to its lower substitution and MW. Several clinical studies have shown the efficacy and safety of PTS in critically ill patient populations including in pump priming during [18] and following [19,20] cardiac bypass, in burn patients [21], in sepsis [22,23] and in trauma [24,25]. While not available in the USA, PTS and other lowersubstituted, medium MW starches are used liberally in European and Canadian intensive care units to resuscitate various forms of shock.…”

Fluid and Electrolyte Therapy in Cardiac Surgery

“…Postoperatif kardiovasküler stabilitenin korunması amacı ile değişik sıvılar kullanılabilir. Postoperatif dönemde kullanılan sıvılarla ilgili olarak çok sayıda prospektif randomize çalışma vardır (20,(49)(50)(51) . Ancak, bu çalışmalardaki hasta sayılarının çok az olması (7 ile 20 arasında değişmekte), volüm replasmanı kriterlerinin tek tip (üniform) olmaması, başlan-gıçta belirlenen günlük dozların çok farklılıklar göster-mesi ve en önemlisi bir grup çalışmada ilave verilecek sıvı miktarı hemodinamik parametrelerle belirlenirken (SVB, PCWB, OAB, KH), diğer çalışmalarda ise belli bir kriter baz alınmaksızın sabit miktar sıvının verildiği hasta gruplarından oluşması tüm bu sonuçların yorumlanmasını güçleştirmektedir.…”