Hydroxyeyhyl starch: Controversies revisited

Datta, Rashmi; Nair, R.; Pandey, Anil; Kumar, Narinder; Sahoo, Tapan Kumar

doi:10.4103/0970-9185.142801

Cited by 15 publications

(9 citation statements)

References 83 publications

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“…In addition, HES infusions are known to significantly reduce factor VIII, von Willebrand factor, and factor VIII–related ristocetin cofactor due to dilution as well as coating of the platelet. Consequently, there is reduced binding to the platelet membrane receptor glycoprotein Ib (GPIb) and GPIIb/GPIIIa and decreased platelet adhesion [ 33 ]. Investigators in several clinical trials have reported that HES is associated with coagulation alterations and increased blood transfusion requirements [ 20 , 21 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

Relationship between a perioperative intravenous fluid administration strategy and acute kidney injury following off-pump coronary artery bypass surgery: an observational study

et al. 2015

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IntroductionSaline-based and hydroxyethyl starch solutions are associated with increased risk of renal dysfunction. In the present study, we tested the hypothesis that balanced solutions and a limited volume of hydroxyethyl starch solution (renal protective fluid management [RPF] strategy) would decrease the incidence of postoperative acute kidney injury (AKI) and improve clinical outcomes in patients undergoing off-pump coronary artery bypass graft surgery (OPCAB).MethodsWe investigated 783 patients who underwent elective OPCAB. All patients who underwent OPCAB between 1 January 2010 and 4 July 2012 formed the control group and were given intravenous fluids with saline-based solutions and unlimited volumes of colloid solutions. All patients who underwent OPCAB between 5 July 2012 and 31 December 2013 formed the RPF group and were given intravenous fluids with RPF. The primary outcome was the incidence of postoperative AKI. Secondary outcomes included the incidence of severe AKI, requirement for renal replacement therapy, renal outcome at the time of discharge, and other clinical outcomes.ResultsPostoperative AKI occurred in 33 patients (14.4 %) in the RPF group compared with 210 patients (37.9 %) in the control group (P < 0.001). The incidences of severe AKI and persistent AKI after OPCAB were significantly lower, and the postoperative extubation time and duration of hospital stay were significantly shorter, in patients in the RPF group than in those in the control group. After adjustment by multivariate regression analyses and inverse probability of treatment weighting adjustment, the RPF group was independently associated with a lower incidence of postoperative AKI, severe AKI, and persistent AKI and a shorter postoperative extubation time and duration of hospital stay.ConclusionsThe RPF strategy is associated with a significantly decreased incidence of postoperative, severe, and persistent AKI in patients undergoing OPCAB, although residual confounding may be present.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-1065-8) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Relationship between a perioperative intravenous fluid administration strategy and acute kidney injury following off-pump coronary artery bypass surgery: an observational study

et al. 2015

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“…Despite reports about HES impairing renal function, 19 there is no evidence in the literature that low molecular weight HES (130 kDa), as it was used in this study, is inferior to other volume replacement regimes concerning renal function and the development of AKI in surgical patients without previous renal dysfunction. 19 Furthermore, a harmful effect of HES-containing infusions on kidney integrity quantified by urinary NGAL could not be demonstrated in on-pump CABG patients. 20 Additionally, there is no evidence for mannitol being more detrimental to tubular epithelia 21,22 in low-risk cardiac surgery patients.…”

Section: Discussionmentioning

confidence: 99%

Renal Function and Urinary Biomarkers in Cardiac Bypass Surgery: A Prospective Randomized Trial Comparing Three Surgical Techniques

Deininger

Hoenicka

Müller-Eising

et al. 2015

Thorac cardiovasc Surg

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Cardiopulmonary bypass procedure is associated with an increased risk of renal impairment. To which extent structural damage causes functional decline is unknown. We evaluated perioperative kidney injury and function in patients treated with conventional extracorporeal circulation (CECC), minimized extracorporeal circulation (MECC), and off-pump coronary artery bypass grafting (OPCAB). Blood and urine samples, collected at baseline and up to 72 hours after surgery from patients of the HEPCON trial (DRKS00007580, 120 patients randomized for heparin management and for surgical technique), were analyzed for differences in renal injury and function. Neutrophil gelatinase-associated lipocalin, α glutathione S-transferase, liver fatty acid-binding protein, and kidney injury molecule-1 were measured as urinary protein markers of renal tubular injury. Serum creatinine, blood urea levels, and estimated glomerular filtration rate were determined to monitor renal function. Markers of tubular injury differed significantly between surgical technique groups early after surgery, indicating the most detrimental effect in CECC. Hemolysis and hemodilution correlated with these early changes. A late rise did not show intergroup differences. Time courses of renal function parameters, as well as the development of acute kidney injury in 15 patients (13.5%), were irrespective of surgical technique. Heparin management did not influence renal parameters. During coronary artery bypass grafting, CECC temporarily induces more tubular injury than MECC or OPCAB. However, late changes of renal function parameters occur irrespective of extracorporeal perfusion mode and even in off-pump surgery.

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“…The ALBIOS trial [ 63 ] reported no difference in mortality rate or RRT when albumin was compared to colloids in sepsis patients. Many large multicenter trials reported a higher incidence of RRT [ 9 – 11 ] and mortality rate [ 10 ] in the HES groups compared to crystalloids in sepsis patients, but they had defects in methodology [ 75 ]. In 2013, the CRISTAL trial [ 76 ] compared crystalloids (isotonic or hypertonic saline and balanced solution) to colloids (gelatin, dextran, HES, and albumin) in patients with hypovolemic shock.…”

Section: Discussionmentioning

confidence: 99%

Intravenous Fluid of Choice in Major Abdominal Surgery: A Systematic Review

Noonpradej

Akaraborworn

2020

Critical Care Research and Practice

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Background. Intravenous fluid therapy plays a role in maintaining the hemodynamic status for tissue perfusion and electrolyte hemostasis during surgery. Recent trials in critically ill patients reported serious side effects of some types of fluids. Since the most suitable type of fluid is debatable, a consensus in perioperative patients has not been reached. Method. We performed a systematic review of randomized control trials (RCTs) that compared two or more types of fluids in major abdominal surgery. The outcomes were related to bleeding, hemodynamic status, length of hospital stay, and complications, such as kidney injury, electrolyte abnormality, major cardiac adverse event, nausea, vomiting, and mortality. A literature search was performed using Medline and EMBASE up to December 2019. The data were pooled to investigate the effect of fluid on macrocirculation and intravascular volume effect. Results. Forty-three RCTs were included. Eighteen fluids were compared: nine were crystalloids and nine were colloids. The results were categorized into macrocirculation and intravascular volume effect, microcirculation, anti-inflammatory parameters, vascular permeability, renal function (colloids), renal function and electrolytes (crystalloids), coagulation and bleeding, return of bowel function, and postoperative nausea vomiting (PONV). We found that no specific type of fluid led to mortality and every type of colloid was equivalent in volume expansion and did not cause kidney injury. However, hydroxyethyl starch and dextran may lead to increased bleeding. Normal saline can cause kidney injury which can lead to renal replacement therapy, and dextrose fluid can decrease PONV. Conclusion. In our opinion, it is safe to give a balanced crystalloid as the maintenance fluid and give a colloid, such as HES130/0.4, 4% gelatin, or human albumin, as a volume expander.

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Hydroxyeyhyl starch: Controversies revisited

Cited by 15 publications

References 83 publications

Relationship between a perioperative intravenous fluid administration strategy and acute kidney injury following off-pump coronary artery bypass surgery: an observational study

Relationship between a perioperative intravenous fluid administration strategy and acute kidney injury following off-pump coronary artery bypass surgery: an observational study

Renal Function and Urinary Biomarkers in Cardiac Bypass Surgery: A Prospective Randomized Trial Comparing Three Surgical Techniques

Intravenous Fluid of Choice in Major Abdominal Surgery: A Systematic Review

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