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At least 865 records · Page 48Linked to original sources
PubMed1980

Plasma volume expansion in the treatment of pre-eclampsia.

The effects of plasma volume expansion with hyperosmolar solutions with the use of dextran 40 and plasmanate were studied in a controlled manner in 32 primiparous pre-eclamptic patients. The patients who were being studied received either dextran 40 (Rheomacrodex) or plasmanate in addition to the routine treatment with sedatives, bed rest, and magnesium sulfate when indicated. The patients were randomly assigned by blind draw to control (13), dextran (10), and plasmanate (nine) groups. The renal status of all patients was evaluated prior to volume expansion therapy. Patients were monitored for blood pressure, proteinuria, output of urine, hematocrit, and creatinine clearance. There was significant improvement in hemoconcentration and output of urine, and a trend toward a lowering of the mean arterial blood pressure in patients who were receiving plasmanate or dextran for volume expansion.

Adolescent↗
PubMed1991

The effect of volume expansion on placental blood flow in awake hypovolemic rats in late pregnancy.

Symptomatic hypovolemia in preeclampsia is often treated by volume expansion. However, the effect of this treatment on placental blood flow is unclear. In the present study the hypothesis was tested that slow volume expansion, imposed on volume-depleted rats, does not compromise placental blood flow. Mild hypovolemia was induced in rats in late pregnancy by 24 hours' thirsting. The resulting gradual dehydration was associated with a 7% reduction in blood volume. These rats were then subjected to blood volume expansion by a continuous infusion with a plasma substitute. Volume expansion increased blood volume by 32% and cardiac output by 73%. The extra cardiac output was distributed to kidneys, carcass, and portal bed. Placental blood flow decreased by 31%. The pattern of response was comparable to the one previously observed in normovolemic rats. However, the magnitude of the changes was larger, probably associated with a delayed or impaired diuretic response. These data suggest that volume expansion therapy in mildly hypovolemic pregnant rats elicits an exaggerated hemodynamic response as compared with normovolemic rats, including placental compromise.

Animals↗
PubMed1986

Volume loading hypoalgesia in SHR, WKY and F1 offspring of a SHR x WKY cross.

The effects of volume loading on a nociceptive reflex, arterial blood pressure and heart rate were studied in spontaneously hypertensive rats (SHRs), Wistar Kyoto normotensive rats (WKYs) and the F1 offspring of a SHR x WKY cross. Volume loading resulted in significantly greater inhibition of the tail-flick reflex to painful radiant heat in SHRs compared to WKYs. The F1 offspring of a SHR x WKY cross showed levels of hypoalgesia to volume loading that were intermediate to those of SHRs and WKYs. There were no differences between these strains in their hypotensive and bradycardic responses to volume loading. These findings are discussed in terms of cardiovascular-somatosensory interactions.

Animals↗
PubMed1978

Vasoconstrictor hyperresponsiveness: an early pathogenic mechanism in the spontaneously hypertensive rat.

Factors which play a primary role in the initiation and development of hypertension in spontaneously hypertensive rats (SHR) are incompletely defined. To test the possibility that early changes in vascular function play a primary etiologic role, hindquarters of 3-week-old SHR and Wistar-Kyoto normotensive rats (WKY) were perfused at constant flow with plasma substitute. The vasculature of SHR exhibited higher resistance to flow than that of WKY. The threshold constrictor response to norepinephrine (NE) was elicited at a significantly lower concentration (6X) than required in WKY, while threshold to BaCl2 was not different. At concentrations of BaCl2 above threshold, SHR exhibited marked hyperresponsiveness compared to WKY. This resulted in a greater maximum response and thus a steeper slope. The ED50 for BaCl2 was not different. A similar dose--response relationship (greater maximum, steeper slope) was observed with NE except that the ED50 as well as threshold was significantly lower in SHR than in WKY. These data show that vasoconstrictor hyperresponsiveness and increased vascular resistance are present at the time when the hypertension is first detectable. The hyperresponsiveness includes two distinct components: (1) A specific hypersensitivity to NE and (2) non-specific hyperresponsiveness which could derive from altered excitation--contraction coupling and/or from a structural mechanism already present when pressure differences begin to appear.

Animals↗
PubMed1979

A simple electrophoretic technique for the estimation of complement C3 conversion: specific application to the investigation of anaphylactoid response to I.V. agents.

A simple electrophoretic technique employing commercially available agarose films is described for the routine estimation of plasma complement C3 conversion. This technique has particular value in the investigation of anaphylactoid responses in patients following the administration of intravenous hypnotic drugs, plasma substitutes or radio-contrast media.

Alfaxalone Alfadolone Mixture↗
PubMed1976

Plasma volume expansion after infusion of 5%, 20% and 25% albumin solutions in patients.

Fifty grams of albumin were infused into patients in the immediate post-operative period as either 5, 20 or 25% solutions. With all three solutions the increase in plasma volume was 500 ml or 11 ml/g of retained albumin, which is less than the normal water-binding capacity of albumin found in studies in vitro and in some clinical studies. This might be explained by a blocking of the water-binding capacity of the albumin or by the action of other unknown mechanisms, when albumin is given in an amount exceeding the losses. The expansion of the plasma volume did not depend on the concentration of the solutions given but only on the amount of albumin given and the deficit in plasma volume. Since albumin is a good plasma expander and a drug with a few secondary effects it is recommended in the treatment of shock. We prefer the 5% solution, which contains an electrolyte solution and is more easily infused, because of its low viscosity.

Adult↗
PubMed1976

Plasma volume changes after infusion of various plasma expanders.

In the immediate post-operative period after moderate surgical procedures, 1 litre of a colloid solution or saline was given intravenously. The plasma volume expansion after infusion of dextran 70 (Macrodex), hydroxyethylstarch (Volex), polygelatin (Haemaccel), albumin and saline was found to be between 790 and 180 ml. The most efficent plasma expander was dextran, followed by hydroxyethylstarch. Polygelatin and saline did not give full restitution, although twice the calculated loss was infused. Total plasma protein concentration was lowered in all groups in proportion to the dilution, except for the patients given albumin, in whom the concentration of total protein increased. Calculation of the total circulating protein mass showed no decrease during the period immediately after the infusion. This investigation has demonstrated that the most efficient plasma volume expander is dextran but that hydroxyethylstarch offers an almost equal alternative in terms of volume expansion. Dextran, however, exerts an advantageous effect on the microcirculation. As the metabolic pathways of hydroxyethylstarch have not yet been further explored, dextran is preferred when using artificial colloids. Judged by its secondary effects alone, including the influence on plasma protein patterns, albumin seems to be the compound of choice. Polygelatin and saline are not efficient expanders when hypovolaemia is to be corrected rapidly.

Adult↗
PubMed1983

Decrease of red blood cell filterability seen in intensive care I. The correlation of low erythrocyte filterability with mortality and its return to normal values in critically ill patients under parenteral nutrition.

Damage to the internal viscosity of red cell is correlated with changes in the surface area to volume ratio and to prelytic phenomena. Considerable changes in shape were noticed in red cells from shocked dogs and some critically ill patients in blood smear or fresh preparation, or after in vitro treatment with colloidal plasma substitutes or glucose, and so erythrocyte filterability was investigated in critically ill patients, given or not given parenteral nutrition. The results revealed an increase of the erythrocyte filtration time (EFT 1/2) in more than 50% of the critically ill patients and less alteration in critically ill patients given total parenteral nutrition, the mortality being half as great. The return of increased EFT 1/2 to normal values occurred after 3-12 days of total parenteral nutrition in 6 patients investigated. A death rate twice as great was seen in patients with high EFT 1/2 as compared to the 27.7% mortality in patients with normal EFT 1/2, its correlation with increased filtration time being significant, r = 0.81 greater than 3 Sr, y = 1.291x + 27.44, n = 47.

Animals↗
PubMed1996

[Indications and role of albumin for vascular loading during prehospital care].

The use of albumin in prehospital care is very limited. Generally, in France, volume loading in acute hypovolaemia is obtained mainly with artificial colloids. However, albumin may be useful in the prehospital care of hypovolaemic pregnant women; but this indication remains theoretical. In many emergency medical services, albumin is available if needed, but the very rare indications and the technical requirements limit its use.

Albumins↗
PubMed1996

[Indications and role of albumin for vascular loading in trauma patients and during preoperative period].

The use of albumin solutions for volume replacement remains controversial. The last American guidelines recommend the use of albumin for resuscitation in case of a contra-indication of artificial colloids or the requirement of sodium restriction. Recent trials did not show any beneficial effect of albumin on the mortality and morbidity rates. Only an improvement of the rheologic conditions has been found with albumin (and dextran 40), in comparison with starch and gelatin. On the basis of cost-effectiveness considerations, artificial colloids should be at this time favoured over albumin for intravascular expansion, except in pregnant women. For resuscitation, albumin could be used when the recommended upper limit of hydroxyethyl starch vol-ume has been reached and fresh frozen plasma not yet required. During preoperative haemodilution, low molecular weight hydroxyethyl starch has at least the same efficacy as albumin. When a rheological effect is required, albumin could be used.

Albumins↗
PubMed1996

[Indications and role of albumin for vascular loading in the operating room].

Prospective clinical studies on albumin and non human colloids, administered peroperatively, were analysed. Only those with a level of evidence I or II were considered. On the basis of the cost-effectiveness ratio, albumin should not be the first choice treatment for peroperative plasma volume expansion. Low molecular weight hydroxyethylstarch is as efficient for restoration and maintenance of volaemia and colloid osmotic pressure. Albumin is administered when other colloids are contra-indicated or when their upper limit of volume has been reached.

Albumins↗
PubMed1996

[Is albumin administration useful in critical care for burnt patients?].

The most typical reaction of the organism after a major burn consists in transcapillary shift from plasma into interstitial space. Capillary hyperpermeability, but also changes in colloid osmotic gradient and decrease in interstitial hydrostatic pressure, explain the fluid shift to burned and, at minor importance, non burned areas during the first post-burn day. The extent of capillary hyperpermeability results in inefficiency of colloid infusions in reducing fluid shift to burned areas. Some groups advocate colloid supply from the eighth post-burn hour, on when hyperpermeability decreases, in non burned sites. However, for most groups, restoration of a functional interstitial space has priority during the 24 first post-burn hours, justifying crystalloid supply without colloids. Furthermore, colloid infusion could be responsible for delayed pulmonary oedema, in the first days following initial fluid replacement. After 24 post-burn hours, in patients experiencing severe albumin depletion, infusion of human albumin is justified, in order to favour oedema resorption.

Albumins↗
PubMed2006

Histophysiological effects of fluid resuscitation on heart, lung and brain tissues in rats with hypovolemia.

The efficacy of using colloids and crystalloids in the treatment of hypovolemia still remains controversial. An important aspect in treating hypovolemia is to re-establish normal tissue hemodynamics after fluid resuscitation. Production of nitric oxide (NO) or growth factors such as transforming growth factor beta (TGF-beta) has been identified as a key mechanism in physiological and pathological processes in the different systems. This study was designed to investigate the histophysiological effects of resuscitation with different plasma substitutes on the heart, lung and brain tissues following acute blood loss in male Sprague-Dawley rats weighing 250-280g (n=30). After anesthesia with sodium pentobarbital, the left femoral vein and artery were cannulated for the administration of volume expanders and for direct measurement of arterial pressure and heart rate. Twenty rats were bled (5ml/10min) and infused (5ml/10min) with one of four randomly selected solutions, (a) human albumin, (b) gelatin (Gelofusine), (c) dextran-70 (Macrodex); or (d) physiological saline (0.9% isotonic saline). Five control rats were bled without infusion. Tissue samples were taken and fixed in 10% formalin solution, then processed for embedding in paraffin wax. Sections were cut and stained with hematoxylin and eosin. Indirect immunohistochemical labelling was performed to reveal binding of primary antibodies against endothelial nitric oxide synthase (eNOS), inducible nitric oxide synthase (iNOS) and TGF-beta. Mild immunoreactivity of eNOS was observed in endothelial cells of vessels in brain, heart and lung tissues. Increased immunoreactivities of eNOS, iNOS and TGF-beta were observed in the non-fluid resuscitated group in these organs; mild, moderate, moderate and strong immunoreactivities were seen in the albumin, gelatin, physiological saline and dextran-70 treated groups, respectively. Immunoreactivities of iNOS and TGF-beta in the non-fluid resuscitated group were increased significantly, in comparison to the other groups, apart from the dextran-70 treated group. The results of this study show that gelatin solution and physiological saline may be of use after acute blood loss, and dextran-70 is not the preferred resuscitation fluid in the early stages of acute blood loss. It was concluded that albumin solution is the preferred fluid for resuscitation.

Animals↗
PubMed1984

Vasoactive factors in the mechanism of renal sodium handling in cirrhotics: the effect of acute plasma expansion.

Twenty cirrhotic patients with ascites, divided into two groups of 10 each, according to their daily urinary sodium excretion (sodium retainers and sodium excretors) and given a diet of 75 mEq of sodium daily, underwent acute plasma volume expansion with 1,000 ml of 10% dextran in saline, infused through a catheter located in the right atrium. Even if a significant increase in sodium excretion was observed in both groups (p less than 0.001 in sodium excretors and p less than 0.05 in sodium retainers), plasma expansion did not reverse sodium retention in sodium retainers. A significant increase in creatinine clearance was found only in sodium retainers (p less than 0.02). Basal plasma renin activity and plasma aldosterone were elevated only in a few patients of both groups. The renin-angiotensin-aldosterone system was highly responsive to plasma expansion. Sodium retainers, who showed an ineffective natriuretic response after expansion, were able to suppress both plasma renin activity and plasma aldosterone in an analogous manner to the sodium-excreting group. This result lends strong support to the concept that the elevated aldosterone level in cirrhosis is not the major determinant of sodium retention. The kallikrein-kinin system was responsive to volume stimulus, since a decrease in kallikrein excretion was noted. It was significant in sodium retainers (p less than 0.05). Plasma PGE1,2 levels were significantly higher in sodium retainers than in controls. This may suggest that there is an activation of the intrarenal prostaglandin system, which could play a protective role against renal ischaemia. After volume expansion, PGE1,2 increased, but not significantly. Octopamine appeared unrelated to sodium excretion and unresponsive to volume stimulus. Endotoxins did not seem to be involved in renal sodium handling. Plasma volume expansion seemed effective in inducing a reduction of vasoconstrictor and sodium-retaining factors, such as the renin-angiotensin-aldosterone system. It is possible to suggest that volume expansion could increase PGE1,2. Plasma volume expansion produced different rates of sodium excretion in the two groups of patients and this suggests that impaired sodium handling in cirrhosis could, to some extent, be independent of effective plasma volume.

Female↗