Fluid therapy with hydroxyethyl starch for massive blood loss during surgery

Area of Science:

• Anesthesiology
• Nephrology
• Hematology

Background:

• Hydroxyethyl starch (HES) products are used for fluid resuscitation.
• HES70/0.55/4 is the lowest molecular weight HES, potentially reducing side effects.
• High-dose administration during surgery warrants safety evaluation.

Purpose of the Study:

• To evaluate the safety of very high dosages of HES70/0.55/4 during surgery.
• To assess the effects of high-dose HES70/0.55/4 on coagulation and renal function post-massive bleeding.
• To clarify renal function up to 1 month after surgery in patients receiving high-dose HES70/0.55/4.

Main Methods:

• Retrospective observational study of 31 patients with >5000 ml blood loss during surgery.
• Analysis of fluid balance and pre/postoperative laboratory data.
• Assessment of acute kidney injury (AKI) and comparison between AKI and non-AKI groups regarding HES70/0.55/4 volume and serum creatinine (Cr) levels.

Main Results:

• Mean blood loss was 8051 ml, with 3085 ml (54 ml/kg) of HES70/0.55/4 infused.
• Postoperative Cr increased, and coagulation parameters (aPTT, PT, INR) were prolonged.
• 13 of 31 patients developed AKI, with 10 recovering by 1 month; no difference in HES70/0.55/4 volume between AKI and non-AKI groups was observed.

Conclusions:

• High-dose HES70/0.55/4 can be safely administered in cases of massive surgical bleeding.
• While HES70/0.55/4 may impact coagulation, significant renal impairment was not evident one month post-surgery.
• Further research may explore specific coagulation effects and long-term renal outcomes.