Comparison of the Effectiveness of Hydroxyethyl Starch (Voluven) Solution With Normal Saline in Hemorrhagic Shock Treatment in Trauma

Abstract

BackgroundAppropriate fluid therapy affects morbidity and mortality rates. A conclusion is yet to be reached on the role of crystalloids and colloids in immediate fluid therapy. This study was done to determine the suitable solution in immediate resuscitation of patients with hemorrhagic shock caused by tissue trauma.MethodsOne hundred trauma patients with hemorrhagic shock, who underwent fluid therapy in the emergency unit, were assigned randomly to two groups of hydroxyethyl starch (Voluven) and normal saline. Before and after fluid therapy, 1 cc of blood was taken from all patients in order to determine and compare base excess levels.ResultsIn hydroxyethyl starch (Voluven) and normal saline groups, base excess level after solution therapy increased about 9.65 and 5.46 volumes, respectively, in which augmentation in hydroxyethyl starch (Voluven) group is significantly higher than normal saline group (P ≤ 0.001).ConclusionBy using hydroxyethyl starch (Voluven) for fluid therapy in hemorrhagic shock caused by trauma, serum base excess decreases and results in improvement in tissue perfusion and better balance in acid-base status and it seems to be superior over normal saline administration, but the building block of the ideal fluid therapy should still remain with the physician’s final clinical judgment.

Hydroxyethyl Starch Improves the Prognosis of Rats with Traumatic Shock via Activation of the ERK Signaling Pathway in Lymphocytes

“…The prognostic survival of the traumatic shock rats was remarkably improved after fluid resuscitation using HES, which is consistent with previous studies [ 11 , 17 ]. It should be noted that in their SD rat models of traumatic hemorrhagic shock, Masoumi et al [ 18 ] discovered that HES resuscitation regulates the balance of TH1/TH2 response, inhibits NF- κ B activation, and promotes CD4+T cell apoptosis of the traumatic hemorrhagic rats, thus improving the immunosuppression, disorder, and inflammation of the rats, which is also in line with our results. In our study, the results of flow cytometry showed that the apoptosis rate of lymphocytes in LR and CON groups was significantly higher than that in sham and HES groups.…”

The protective effect of hydroxyethyl starch solution on the glycocalyx layer in an acute hemorrhage mouse model

“…There are many reports on the effects of HES130 administration in patients with massive hemorrhages; HES130 has been shown to shorten the recovery time from shock [12], improve peripheral circulation and vascular permeability, improve the symptoms of edema in small intestinal mucosa [30], and decrease the concentrations of GCX fragmentation products (syndecan-1, heparanase, and hyaluronic acid) [31]. In addition, in a clinical study of HES130 treatment in trauma patients, an improvement of base excess [32] and lactic acid levels was reported. Rossaint et al reported that HES130 treatment reduced neutrophil-platelet aggregates, chemokine-induced arrest, and the transmigration of neutrophils; HES130 has also been found to have antiinflammatory effects [14].…”

A Comparison Between the Effects of Preloading with Ringer's Solution and Voluven on Hemodynamic Changes in Patients Undergoing Elective Cesarean Section Under Spinal Anesthesia

“…Crystalloids by entering extravascular space may not completely replace intravascular space. Some studies have demonstrated that administration of Voluven and crystalloid fluids showed no significant difference between the two groups of the patients in the hemodynamic parameters (10, 16). Considering the importance of hemodynamic stability during SA, especially in pregnant women, and the presence of the contradictory results from earlier studies.…”