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[Volume replacement solutions--pharmacology and clinical use]
H A Adams1, S Piepenbrock, G Hempelmann
1Zentrum Anästhesiologie-Anästhesiologie I, Medizinische Hochschule Hannover.
Summary
Maintaining adequate intravascular volume is crucial for oxygen transport. Volume replacement strategies involve crystalloids and colloids, with hydroxyethyl starch (HES) and gelatin offering distinct clinical benefits for fluid resuscitation.
Area of Science:
- Physiology and Pathophysiology
- Pharmacology
Context:
- Total body water comprises intracellular and extracellular fluid compartments, with plasma volume maintained by colloid oncotic pressure (COP).
- Normovolaemic haemodilution can improve oxygen transport capacity, with critical hemoglobin concentrations defined for intensive care patients.
Purpose:
- To review volume replacement strategies using crystalloid and colloid solutions.
- To compare the pharmacological characteristics and clinical applications of synthetic colloids like gelatin, dextran, and hydroxyethyl starch (HES).
Summary:
- Crystalloid solutions lack intrinsic COP and distribute widely, requiring larger volumes for equivalent effects compared to colloids.
- Synthetic colloids (gelatin, dextran, HES) possess COP, retaining fluid intravascularly; HES and gelatin offer specific advantages in volume replacement and managing blood loss.
- Albumin use is limited, with 5% albumin not recommended for volume replacement and 20% albumin reserved for specific intensive care scenarios.
Impact:
- Understanding the properties and indications of different volume replacement solutions is essential for effective fluid management in critical care.
- The choice of colloid depends on factors like volume demand, duration of effect, and potential impact on hemostasis and renal function.