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Do plasma substitutes have additional properties beyond correcting volume deficits?

Joachim Boldt1

  • 1Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Bremserstrasse 79, D-67063 Ludwigshafen, Germany. BoldtJ@gmx.net

Shock (Augusta, Ga.)
|March 10, 2006
PubMed
Summary

Choosing the best fluid therapy involves more than just volume. Different plasma substitutes have varying effects on organs and tissues, impacting critical care decisions.

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Area of Science:

  • Critical Care Medicine
  • Pharmacology
  • Physiology

Background:

  • Volume therapy strategies lack universally accepted guidelines.
  • Plasma substitutes may offer organ-specific benefits beyond fluid replacement.
  • Evidence suggests potential differences in these additional effects among various plasma substitutes.

Purpose of the Study:

  • To review and analyze the additional effects of plasma substitutes.
  • To compare the differential impacts of various plasma substitutes on organ perfusion, microcirculation, and tissue oxygenation.
  • To assess the translation of experimental findings to human clinical practice.

Main Methods:

  • Literature review of experimental and human studies on plasma substitutes.
  • Analysis of data on effects on organ perfusion, microcirculation, tissue oxygenation, inflammation, endothelial activation, capillary leakage, and tissue edema.

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  • Comparison of findings with current clinical recommendations for volume deficits.

    • Main Results:

    • Studies show non-uniform effects of plasma substitutes, ranging from beneficial to detrimental.
    • Crystalloids, despite negative effects on microcirculation and organ perfusion, remain a common first-choice therapy.
    • Experimental data on hypertonic solutions suggest benefits not yet confirmed in human trials.

    Conclusions:

    • Current volume therapy recommendations may not fully incorporate the additional effects of plasma substitutes.
    • Future fluid management in critically ill patients should consider organ-specific impacts beyond mere volume restoration.
    • Further human studies are needed to elucidate the differential effects of plasma substitutes for optimized critical care.