Hydroxyethyl starches in equine medicine

Abstract

Objective To review and discuss the use of hydroxyethyl starches (HES) in equine veterinary medicine, and to provide recommendations for its use. Data sources Veterinary and human peer‐reviewed medical literature including scientific reviews, meta‐analyses, and original research articles. Human data synthesis Increasing evidences on adverse effects after HES use and decreasing support for beneficial effects with regards to volume expansion and colloid osmotic pressure (COP) support in critically ill subjects have led to a recent guideline to limit the use of HES in critically ill people. Equine veterinary data synthesis The rationale for HES use in horses is mainly extrapolated from human medicine, and very limited studies in horses are available. There is limited evidence suggesting a superiority of volume expansion effects of HES over crystalloids. The potential for HES to increase and maintain COP is well supported, but there is no evidence that maintaining or increasing plasma COP influences outcome, tissue edema formation, or rates of complications that potentially relate to edema formation. HES induce dose–dependent changes in coagulopathic parameters, but there is no evidence that HES causes clinical coagulopathies. Insufficient data are available on other adverse effects such as acute kidney injury, or mortality in horses. The use of HES should be restricted in septic patients, but may still have some use in cases of hemorrhagic shock resuscitation, hypoalbuminemia, or perioperative fluid replacement. Conclusion The evidence supporting the use of HES in horses is weak due to lack of species‐specific investigations. Acknowledging species differences, the use of HES should be judicious, yet with some recognition of its benefits in particular cases. More research is necessary to improve knowledge on use of HES in horses and to establish better future recommendations.

Flow rates of double‐lumen over‐the‐wire catheters for high‐volume fluid resuscitation in large animal species

“…Nonpressurized in vitro flow rates for synthetic colloid varied from 24 L/h (C5) to 43 L/h (C1), therefore all evaluated catheters would be able to deliver the maximum colloid daily dose 1,[23][24][25] (5 L for a 500-kg horse) in a very short period of time. Administration of colloids in association with crystalloids is desired in severely hypovolemic horses that are also hypoproteinemic 1,26 or as a fluid replacement strategy to provide rapid high-volume expansion as well as interstitial rehydration. 27 Double-lumen catheters permit simultaneous administration of colloid and crystalloid in independent ports; however, further studies are needed to evaluate the flow rate of each lumen in this scenario and whether this would support a faster and more effective fluid resuscitation.…”

Intravenous Fluid Administration and the Coagulation System

“…Synthetic colloid-containing fluids are commonly administered for fluid resuscitation in small animals (60) and horses (61). They are favored by some veterinarians for their potential to maintain intravascular colloid osmotic pressure and expand blood volume more effectively for a given infused volume than isotonic crystalloids (8,43,62).…”

Assessment of Hydroxyethyl Starch (6% HES 130/0.4) Kidney Storage in Critically Ill Dogs: A Post-mortem Prospective Study

“…Since its introduction in the 1970's, several HES products with varying physicochemical properties, such as molecular weight (MW) and degree and pattern of hydroxyethylation, were developed. HES solutions were commonly used as an intravenous plasma expander to prevent or treat hypovolemia and hypotension in people and companion animals, including dogs, cats, and horses (2)(3)(4)(5). However, coagulopathy, kidney injury, tissue storage, and pruritus are well-known side effects of HES in humans (6).…”