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Saline versus balanced hydroxyethyl starch: does it matter?

Joachim Boldt1

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

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Area of Science:

  • Critical care medicine
  • Fluid resuscitation
  • Pharmacology

Background:

  • Hypovolemia correction requires fluid replacement strategies.
  • A total balanced volume replacement strategy necessitates balanced colloids alongside crystalloids.
  • Conventional hydroxyethyl starch (HES) solutions use saline with high sodium and chloride concentrations.

Purpose of the Study:

  • To evaluate the effects of balanced hydroxyethyl starch (HES) solutions compared to conventional HES.
  • To assess the impact of plasma-adapted HES on acid-base status and coagulation.
  • To explore the potential of balanced HES in a total balanced volume replacement strategy.

Main Methods:

  • Review of animal and human studies on balanced and conventional HES solutions.
  • Analysis of effects on acid-base balance, including base excess.
  • Assessment of coagulation parameters using thrombelastography and platelet aggregation.

Main Results:

  • Plasma-adapted HES demonstrated beneficial effects on acid-base status compared to saline-based HES.
  • Infusion of unbalanced HES may lead to inappropriate clinical interventions due to low base excess.
  • Balanced HES preparations showed significantly fewer alterations in coagulation and less negative impact on thrombelastography and platelet aggregation.

Conclusions:

  • Using plasma-adapted HES solutions is preferable to conventional HES in unphysiologic saline.
  • Initial results for balanced HES are promising.
  • Larger clinical trials are needed to confirm the value of total balanced volume replacement with plasma-adapted HES.