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Volume therapy in the critically ill: is there a difference?

J Boldt1, M Müller, D Mentges

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

Intensive Care Medicine
|March 21, 1998
PubMed
Summary
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Hydroxyethylstarch solution (HES) showed no disadvantages compared to human albumin (HA) for 5-day fluid replacement in critically ill patients. HES demonstrated improved hemodynamics and is a cost-effective alternative for prolonged volume therapy.

Area of Science:

  • Critical Care Medicine
  • Pharmacology
  • Nephrology

Background:

  • Concerns exist regarding prolonged hydroxyethylstarch solution (HES) use in critically ill patients.
  • Human albumin (HA) is a common alternative for volume replacement therapy.

Purpose of the Study:

  • To compare the effects of 5-day volume replacement with HES versus HA on hemodynamics, laboratory data, and organ function in critically ill patients.
  • To evaluate the cost-effectiveness of HES compared to HA.

Main Methods:

  • Prospective, randomized study in a surgical intensive care unit.
  • 150 trauma patients and 150 sepsis patients received either 10% HES or 20% HA for 5 days.
  • Hemodynamic parameters, laboratory data, and organ function were monitored daily.

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Main Results:

  • No significant differences in mortality or incidence of pulmonary, renal, or hepatic failure between HES and HA groups.
  • HES group showed higher cardiac index, oxygen delivery, and oxygen consumption compared to HA group.
  • Lactate concentrations decreased in HES-sepsis patients; HES therapy was significantly less costly than HA.

Conclusions:

  • Five-day volume therapy with 10% HES is not disadvantageous compared to 20% HA in ICU patients.
  • HES may improve hemodynamics and represents a cost-effective alternative for prolonged fluid therapy.
  • HES is a valuable and cheaper alternative to albumin for critically ill patients.