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PubMedDate not supplied

Highly substituted hydroxyethyl starch (HES200/0.62) leads to Type-I von Willebrand syndrome after repeated administration.

Hydroxyethyl starch (HES) is a frequently used plasma substitute that is popular due to a high degree of therapeutic safety. However, the administration of large volumes of highly substituted, high-molecular-weight starch often leads to iatrogenic von Willebrand syndrome (vWS) with hemorrhagic complications. In patients with cerebral circulatory disturbances we carried out hemodilution therapy during 9-10 days, infusing HES 200/0.62. A von Willebrand factor (vWF) multimeric analysis was carried out in 6 patients using a modified western blot according to the sodium dodecyl sulfate agarose gel electrophoresis method. The vWF multimeric analysis showed that all multimers decreased to the same degree, corresponding to type-I vWS.

Aged↗
PubMedDate not supplied

[Hemodilution in the treatment of cerebrovascular disorders].

Haemodilution includes intravenous administration of plasma-replacing solutions and/or blood letting for changing the rheological properties of blood, and for improvement of microcirculation. Three methods of haemodilution various plasma substitutes are given: dextran, hydroxyethyl starch (HES), electrolyte solutions (e.g. Ringer's solution, normal saline, 5% glucose, colloidal plasma, protein solutions), plasma, albumins. The controversial results of clinical trials of the method for therapeutic purposes are discussed. In the light of the reports as yet, it seems that the best results are obtained using normovolaemic haemodilution with administration of HES.

Blood Volume↗
PubMed1986

[Comparison of volume substitutes 5 percent human albumin and 6 percent hydroxyethyl starch (40,000/0.5) in pediatric anesthesia].

Human albumin 5% (HA), frequently used in paediatric anaesthesia as a human plasma substitute, could be replaced by hydroxyethyl starch 6% (HES) 40,000/0.5 provided its use would not entail any disadvantages but rather advantages instead. This problem was studied by examining 30 children (mean body weight 32.5 kg) in general anaesthesia. During about 3 hours of surgery the patients lost up to 15 per cent (approx. 400 ml) of blood volume. In a randomised study the blood loss was compensated either via HA or HES with 14 ml/kg body weight each, respectively. Blood pressure and pulse rate remained within the normal range. Haemodilution was represented by a drop in the erythrocyte count to about 3 million/microliter, haematocrit (HCT) to about 30% and haemoglobin to approx. 10 g/100 ml. Slight metabolic acidosis (Bodansky unit = -4 mmol/l) was found to be statistically not significant (= n.s.) with both methods, as was the difference in serum albumin and during serum electrophoresis. Serum [Na+] was reduced in those children who had been treated with HES, to 137.33 +/- 33.30 mmol/l; however, in those children who received HA with low sodium content (statistically significant difference = s.s.) the corresponding level was 134.15 +/- 2.36 mmol/l. Serum creatinine rose in each case from 60 to 80 mmol/l (s.s.), renal function being slightly impaired probably due to the anaesthesia and surgery. The value according to Quick's test and the partial thromboplastin time (PTT) remained in the normal range both with HA and HES treatment (in each case over 70% and below 25s, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)

Acid-Base Equilibrium↗
PubMed1977

Blood and blood substitutes for treating hemorragic shock.

Blood substitute products for the treatment of hemorrhagic shock are discussed with regard to their composition, physical and therapeutic characteristics, adverse effects, cost, and market availability. Commercially available plasma expanders discussed include blood derivatives (whole blood, packed red blood cells, plasma, normal human serum albumin, and plasma protein fraction), synthetic colloids (dextrans 40 and 70) and a balanced salt solution (lactated Ringer's injection). Plasma substitutes alone are administered until the hematocrit falls below 30% of coagulation difficulties develop. Normal serum albumin 5% and plasma protein fraction 5% are excellent colloidal plasma expanders without the potential hazard of hepatitis. Lactated Ringer's injection is the fluid of choice to replace lost blood up to 10% of the vascular volume.

Blood Proteins↗
PubMed1982

Biophysical properties of resuscitation fluids.

The preliminary results of this study indicate that the biophysical characteristics of stroma-free hemoglobin solution (SFH) make it an extremely suitable blood substitute. At the concentration that is currently being considered as an infusing solution (70 g/L), it is a Newtonian fluid having a viscosity very similar to that of plasma. At this concentration, SFH also has very favorable hemodilution properties, as well as potential oxygen transport ability, which most expanders lack. There seems to be little interaction between the plasma proteins and SFH, as indicated from viscosity measurements. The osmotic behavior of SFH indicates that it approaches an ideal polymer-solvent system as illustrated by the small value of the second virial coefficient, especially when compared to other plasma substitutes. In mixtures with whole blood at a series of hematocrits, SFH seems to be hyperosmotic. This biophysical property could certainly have significance in patients with severe shock. SFH maintains the integrity of whole blood and does not initiate erythrocyte aggregation. The investigations of the erythrocyte sedimentation rate (ESR) in this study with SFH indicate the potential usefulness of SFH in maintaining stability of these systems, particularly during the treatment of shock. The transport properties of the red cell membrane are apparently not effectively altered by the presence of SFH. This has been illustrated in the hemolytic malonamide kinetic and osmotic fragility studies. Although the results are preliminary, it should be stressed that SFH may offer protection against hemolysis when used as a transfusion solution.

Biological Transport↗
PubMedDate not supplied

Studies concerning the viability of the preserved kidney with perfusates other than plasma.

Based on previous data, this research deals with the study of cellular ultrastructure of renal tissue (cortical and medullary) in conditions of preservation through a continuous hypothermic pulsatile perfusion, using a solution that substitutes plasma as the perfusate. This experiment was done on isolated dog kidneys perfused with a specialized perfusion machine. The results clearly show that with this method of renal preservation, no major lesions or irreversible modifications of the nephrons occur within 12 hours, offering the organ posttransplanting compatibility.

Animals↗
PubMed1977

[Qualities and application of macromolecular volume substitutes (author's transl)].

The effective volume substitution in shock requires normalizing of the circulating blood volume as well as the restitution of microcirculation. Saline solutions are unsuited for their missed oncotic efficiency and their short intravenous staying. Also stored blood is unsuitable because of its rheological properties, plasma protein preparations for economical and infectious reasons. The different qualities and effects of the known plasma substitutes on the basis of dextran, gelatine and starch are described, their special indications being explained. Haemodilution and the so-called secondary effects limit the dosage of volume substitution.

Adult↗
PubMed2000

Lung lymph response to overinfusion with hydroxyethyl starch in sheep. Comparative studies of high and low molecular weight compounds.

BACKGROUND: Several hydroxyethyl starch (HES) solutions are available clinically. We performed comparative studies of low and high molecular weight HES to evaluate the effects on lung lymph flow in sheep, to see the difference in the types of HES. METHODS: We prepared awake sheep with vascular monitorings and lung lymph fistulas. We measured systemic artery pressure (Psa), pulmonary artery pressure (Ppa), and left atrial pressure (Pla) continuously. Cardiac output (CO) was measured every 30 min. Lung lymph flow (Qlym) was collected every 15 min. After baseline measurements, two HES solutions were infused over 2 h, respectively. Experiment 1 (n=6): low molecular weight HES (MW 70 000, substitution ratio 0.5-0.55), Experiment 2 (n=5): high molecular weight HES (MW 450 000, substitution ratio 0.7). RESULTS: Both low and high molecular HES behaved similarly as a volume expander, increasing Psa, CO, Pla and Ppa, and decreasing hematocrit. In addition, the actual oncotic pressure gradient (plasma - lymph) was widened after the start of either low or high molecular HES, but the value for high molecular HES was significantly higher than that for low molecular HES. Qlym of low molecular HES rose significantly from the baseline and the percent increase in Qlym for low molecular HES was significantly higher than that for high molecular HES. CONCLUSION: These data suggest that low molecular HES is as useful a plasma substitute as high molecular HES, but may increase lung fluid filtration in the overinfused state.

Animals↗
PubMed1975

[The influence of hydroxyethyl starch solutions on circulation and on kidney function in hypovolaemic patients (author's transl)].

In a group of 12 hypovolemic patients some parameters of circulation and kidney function were measured before and after an infusion of 1000 ml 6% hydroxyethyl starch solution (HES) was given. There were found increases in cardiac output, centralvenous pressure and endogenous creatinine clearance, and decreases of total peripheral resistance and shock index. Under the conditions of this investigation HES solution showed good properties as a plasma substitute.

Blood Circulation↗
PubMed1996

A randomized trial comparing the effect of prophylactic intravenous fresh frozen plasma, gelatin or glucose on early mortality and morbidity in preterm babies. The Northern Neonatal Nursing Initiative [NNNI] Trial Group.

UNLABELLED: Seven hundred and seventy-six children born before 32 weeks gestation between 1990 and 1992 were randomly allocated within 2 h of birth to one of three groups: either prophylactic fresh frozen plasma (20 ml/kg followed by 10 ml/kg after 24 h); or a similar volume of an inert gelatin plasma substitute (Gelofusine); or control management with a maintenance infusion of 10% dextrose. The three groups were similar at trial entry. There were no statistically significant differences in the number of deaths before discharge (fresh frozen plasma 19.1%, gelatin 22.0% and control 17.8%). Death or disability amongst long-term survivors at 2 years of age is the primary trial outcome variable: this information is not yet available. Death before discharge from hospital or the presence of a cerebral ultrasound scan abnormality 1 or 6 weeks after birth in survivors was a pre-defined secondary outcome variable (although 176 long-term survivors never had a scan, largely because they never needed care in a unit staffed to provide prolonged respiratory support or a routine scan service). Of the children entered into the three arms of the trial, 43.0%, 37.5% and 42.3% respectively died or were known to have developed at least a minor cerebral ultrasound abnormality before discharge. The proportions dead or known to have developed a major scan abnormality (ventriculomegaly or a persisting parenchymal abnormality), were 22.7%, 27.0% and 23.3%. CONCLUSION: Neither early prophylactic volume expansion, nor a coagulation factor supplement, had any detectable effect on short-term outcome in this large multicentre open trial.

Brain Ischemia↗
PubMed1978

Red cells and gelatin as the core of a unified program for the national procurement of blood components and derivatives. Prediction, performance, and impact on supply of albumin and factor VIII.

The use of a gelatin plasma substitute as an integral part of a unified national program for the procurement of blood components and derivatives paves the way for the extensive use of red cell concentrates in the treatment of hemorrhage, the plasma from the original donations being partly diverted to the fractionation program of a national transfusion service. We estimated the potential of such a system paced by the demand for red cells and predicted that the use of 20% of fresh whole blood and 80% concentrates would not increase the demand for albumin, the yield of which would suffice to cover three-quarters of current needs in our country. The actual performance of a program using 85% of red cell concentrates in a university hospital with an exceptionally high incidence of major hemorrhage was analyzed in detail. The use of albumin per unit of transfused red cells rose by 9%. With a nationwide increase of this magnitude, 67% of the demand in our country could still be met and the estimated true need for albumin of 200 kg per million inhabitants and year would be fully covered. The yield of factor VIII is 200--300% of the demand. The determinants of the effects of such a system vary from country to country, but its fundamental potential is obviously considerable.

Blood Proteins↗
PubMed1985

Influence of intravenous infusions of hydroxyethylstarch (HES) (MW 40,000 and 450,000) on the blood flow properties of healthy volunteers.

Infusions of hydroxyethylstarch (HES) solutions as plasma substitutes and flow improvers play an increasing role in the treatment of various diseases. Little is known about the effect of HES solutions of different molecular weights on the flow properties of blood i.e. blood viscosity, plasma viscosity, erythrocyte aggregation and erythrocyte deformability (filtrability). In the present study the influence of 500 ml-infusions of a 6% solution of HES (MW 450,000) has been compared to that of 6% solutions of HES 40,000. Infusions of 500 ml of HES 450,000 into healthy persons induced a hemodilution with a subsequent decrease in whole blood viscosity whereas the plasma viscosity increased. Red cell aggregation increased as well, red cell deformability was slightly impaired. Infusions of 500 ml of HES 40,000 into healthy persons were followed by a hemodilution with a decrease in blood and plasma viscosity, a decrease in erythrocyte aggregation and a slight improvement of red cell deformability. The reason for this difference in behaviour and its therapeutical consequences are discussed.

Adult↗
PubMed1975

Immediate care after aspiration of vomit.

The diagnosis of aspiration can be made from the characteristic clinical features. Management is then based on the measurement of the pH of the gastric contents, blood gases and acid-base values, the serial measurement of pulse blood pressure and central venous pressure, and the haemoglobin and haematocrit. If available measurement of the plasma or blood volume, pulmonary artery and wedge pressure and cardiac output may also be of value in diagnosis and guiding treatment. The following treatment should be carried out: Head down in right lateral position to drain vomit from airway. Suction. Laryngoscopy to clear the airway. Bronchoscophy if asphyxiated by solid material. Endotracheal intubation if liquid. High inspired oxygen. Artificial ventilation if the PO2 is low. Steroids Hydrocortisone 200 mg intravenously and 100 mg intramuscularly every 6 hours; or Dexamethasone 10 mg intravenously and 5 mg intramuscularly every 6 hours. Aminophylline if bronchospasm is severe. Plasma or plasma substitute for hypotension and hypovolaemia. Correct acidosis.

Acidosis↗
PubMedDate not supplied

[Basic intensive care of ischemic cerebral stroke. Method of therapeutic hemodilution].

Ischemic cerebral stroke (ICS) ranks among the most frequent causes of disability. The incidence of untoward consequences of ICS can be decreased by early adequate use of intensive care methods restoring tissue oxygenation in the focus. The most important methods of intensive care of ICS are measures notably improving microcirculation and essentially decreasing subsequent incidence of disabling complications. The basic component of intensive care ensuring favorable results is therapeutic hemodilution making use of modern plasma substitutes--second-generation hydroxyethyl starch Infukoll HES 6 and 10% solutions. Currently used methods including use of dextran-based solutions cannot normalize microcirculation in ICS patients, particularly if used in long course. Prolonged infusions of dextran-based solutions inevitably increases plasma viscosity and impairs the hemostasis system. An essential increase of plasma viscosity involves the need in a complex of appropriate drug therapy aimed at compensation for untoward aftereffects of high dextran doses. Therapeutic doses of dextran-based solutions do not notably improve blood rheology. By contrast, therapeutic hemodilution with Infukoll HES notably improves the results of intensive care of ICS.

Blood Viscosity↗
PubMed1998

Plasma volume expansion with Haemaccel does not impair haemostasis during reduction mammaplasty.

OBJECTIVES: An in vivo study under well-controlled conditions was undertaken to determine the effect of Haemaccel, a colloidal plasma volume expander, on normal haemostasis. METHODOLOGY: Twenty patients, who were admitted for reduction mammaplasty, were included in this study. A standardised anaesthesia protocol was followed with all patients. Ten patients received 500 ml Haemaccel and 10 controls received 1,500 ml Ringer's lactate, a crystalloid solution. The solutions were administered intravenously during surgery over a period of 30-40 minutes. Standardised clinical observations and haematological tests were done at the following time intervals: after anaesthesia but before infusion of the plasma substitute, immediately after infusion was completed, and 20, 40 and 60 minutes after infusion. RESULTS: The blood pressure, pulse rate and O2 saturation levels were not influenced by the treatment given. Haemodilution was similar for the two patient groups. The platelet count and plasma levels of fibrinogen decreased in parallel with haemodilution. Thereafter the platelet count gradually increased to pre-infusion counts at 60 minutes. The prothrombin time (PT), activated partial thromboplastin time (aPTT), thrombin time (TT) and platelet aggregation in response to adenosine diphosphate (ADP) and collagen were not affected by the plasma volume expander given. Arachidonic acid-induced aggregation decreased significantly after Ringer's lactate was given but did not change when Haemaccel was given. The bleeding time was prolonged slightly, but not significantly, from 7.4 +/- 1.6 minutes to 8.8 +/- 1.6 minutes with Ringer's lactate and from 6.9 +/- 2.0 to 9.7 +/- 3.7 minutes with Haemaccel. CONCLUSIONS: We could not find any scientific evidence that Haemaccel affects haemostasis; neither does it increase bleeding relative to Ringer's lactate.

Adult↗
PubMed1997

Anuric acute renal failure caused by dextran 40 administration.

Dextran 40 is largely used in clinical medicine as a plasma substitute because of its beneficial effects on the microcirculation and antithrombogenic properties. An unusual adverse reaction of dextran administration is oligoanuric acute renal failure. We report two cases of anuric ARF induced by dextran 40. Diuresis and renal function were quickly resumed after plasma-pheresis treatment. Renal biopsy revealed normal kidneys except for swelling and vacuolation of renal tubules suggestive of osmotic nephrosis.

Acute Kidney Injury↗