Hemodynamic and Oxygen Transport Effects of Pentastarch in Burn Resuscitation

Abstract

If nonprotein colloid plasma expanders could be demonstrated to be safe and efficacious in burn resuscitation, a significant cost benefit would result. This study was a randomized cross-over comparison of 500 ml of 5% albumin and 500 ml of 10% pentastarch, a new hydroxyethyl starch, in acute burn resuscitation. Pentastarch was an effective plasma expander, resulting in increases of preload, cardiac output, oxygen delivery, and oxygen consumption; the hemodynamic effects of pentastarch infusion were equal or superior to those of albumin. Both albumin and pentastarch infusions resulted in increased bleeding and clotting times; these effects were most likely dilutional. Pentastarch is a promising plasma substitute for burn resuscitation; the effects of a 500 ml infusion are equal or superior to those of albumin. Further study is necessary to assess the safety of larger infusion volumes.

Hemodynamic effects of 6% and 10% hydroxyethyl starch solutions versus 4% albumin solution in septic patients

“…The increase in CI with the 10% HES solution was associated with an only modest increase in DO 2 because the solution caused the greatest degree of hemodilution and, consequently, the greatest decrease in the Hb levels. This hemodiluting effect is consistent with other studies in surgical and clinical patients, indicating that HES 10% administration resulted in augmented plasma volume [9,14,19,20].…”

The Phenomenon of “Fluid Creep” in Acute Burn Resuscitation

“…55 A few centers have also used limited amounts of synthetic colloids such as hetastarch for routine burn resuscitation, with good results. 117,118 Thus, administration of colloid may reduce the consequences of fluid creep even if it does not directly address its causes.…”

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.…”