[Comparison of 5% human albumin and 6% 200/0.5 HES as exclusive colloid components in large surgical interventions]

It was the purpose of the following study to compare effects of 6% hydroxyethyl starch 200/0.5 (HES) and albumin 5% (HA5) on haemostasis, haemodynamics, oncotic function and plasmatic homoeostasis.

In 2 randomised groups of 20 patients each undergoing large surgery (criteria of exclusion: anaemia, renal, liver, and coagulation disorders, ASA classification > III) we treated up to 1000 ml with colloid solution, from 1000 ml up to 5000 ml with packed red blood cells (PRBC) and colloid solution (1:1) and above 5000 ml with PRBC and fresh frozen plasma (1:1). Group HES received HES and group HA5 albumin as exclusive colloid component and both continuously lactated Ringers' at a rate of 500 ml/h. We measured the parameters before operation, after each 1000 ml colloid up to 3000 ml application and at the end of operation and we registered total blood output/intake.

We found comparable amounts of blood loss and blood intake (mean total amount of colloid solution: HES 2044 +/- 579 ml; HA5 2547 +/- 980 ml). We didn't find any differences in haemodynamics nor in haematocrit, platelets or global coagulation parameters which only showed dilutional influences. Differences existed in total serum protein (HES 32.8 +/- 6.5 gr/l; HA5 54 +/- 5.5 gr/l at OP's end); however COP was maintained in both groups during the whole study period at normal ranges. Plasmatic haemostasis showed to a large extent corresponding values. Remarkable was the development of a metabolic acidosis in the HA5 group.

Regarding total blood output/intake, haemodynamic functions, haematological parameters, coagulation, oncotic function, and plasmatic homoeostasis, HES is a safe colloid if contra-indications are taken into account, capable of replacing albumin 5% entirely as a colloid component of treatment of even large blood losses intraoperatively above the recommended dose of 20 ml/kg BW/d.