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Updated: May 17, 2026

Fixed Volume or Fixed Pressure: A Murine Model of Hemorrhagic Shock
16:31

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Published on: June 6, 2011

Balanced crystalloid compared with balanced colloid solution using a goal-directed haemodynamic algorithm.

A Feldheiser1, V Pavlova, T Bonomo

  • 1Department of Anaesthesiology and Intensive Care Medicine, European Competence Center for Ovarian Cancer, Charité-Universitaetsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany.

British Journal of Anaesthesia
|November 1, 2012
PubMed
Summary
This summary is machine-generated.

Balanced hydroxyethyl starch (HES) solutions improved hemodynamic stability and reduced fresh-frozen plasma transfusions in ovarian cancer surgery. These colloid solutions showed no signs of renal impairment when fluid administration targeted cardiac preload optimization.

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Area of Science:

  • Anesthesiology
  • Critical Care Medicine
  • Surgical Oncology

Background:

  • Optimal intravenous fluid selection for goal-directed hemodynamic management remains debated.
  • This study addresses the controversy by comparing balanced crystalloids and balanced hydroxyethyl starch (HES) solutions.

Purpose of the Study:

  • To evaluate the efficacy and safety of balanced hydroxyethyl starch (HES) versus balanced crystalloid solutions in patients undergoing cytoreductive surgery for ovarian cancer.
  • To assess hemodynamic stability, fluid administration requirements, and renal function markers under a goal-directed hemodynamic algorithm.

Main Methods:

  • A double-blind pilot study involving 50 patients with ovarian cancer undergoing cytoreductive surgery.
  • Random assignment to receive either balanced crystalloid or balanced hydroxyethyl starch (HES, 130/0.4, 6%) solutions.
  • Fluid administration guided by a goal-directed hemodynamic algorithm to optimize stroke volume measured by esophageal Doppler, up to a 50 ml/kg dose limit.

Main Results:

  • Balanced HES solution demonstrated superior stroke volume maintenance with less fluid administration compared to crystalloids (P=0.012).
  • The HES group experienced less frequent (92% vs 62%, P=0.036) and later (2:26 vs 3:33 h, P=0.006) achievement of study dose limits.
  • Patients receiving HES required significantly fewer fresh-frozen plasma units (3.5 vs 6.0 units, P=0.035), with similar intra/postoperative urine output and renal injury markers (creatinine, NGAL).

Conclusions:

  • Balanced HES solutions are associated with enhanced hemodynamic stability and a reduced need for fresh-frozen plasma transfusions when used with a goal-directed hemodynamic algorithm.
  • Colloid solutions, specifically balanced HES, did not exhibit signs of renal impairment in this cohort when fluid administration was targeted to optimize cardiac preload.