J Korean Med Assoc.  2013 Oct;56(10):924-932. 10.5124/jkma.2013.56.10.924.

Plasma volume expanders: classification and characteristics of colloids

• Lee JJ
• Kim JH

• KMID: 2193417
• DOI: http://doi.org/10.5124/jkma.2013.56.10.924

Abstract

Fluid therapy remains an important therapeutic maneuver in managing surgical, medical, and the critically ill intensive care patient. However, the ideal volume replacement strategy remains under debate. The debate on whether patients should be managed with crystalloids, colloids, or both has for many years been mainly a debate about effectiveness. The dispute over crystalloids versus colloids has been enlarged to a colloid versus colloid debate because of the varying properties of different colloids. The natural colloid albumin and artificial colloids such as gelatin, dextran, and hydroxyethyl starch continue to enjoy widespread usage for clinical fluid management. Colloid is an effective plasma volume expander and is able to restore the hemodynamic profile with less total volume than crystalloid. However, colloid is associated with coagulation abnormalities, renal impairment, and allergic reactions. Albumin is considered to be one of the safe colloids. However, due to its cost, albumin cannot be recommended for hypovolemia. Gelatin and dextran can also cause coagulation abnormalities and renal impairment. Dextran is not used anymore due to its high anaphylactic potency. Each hydroxyethyl starch has different properties by concentration, mean molecular weight, molar substitution, and its C2/C6 ratio. New hydroxyethyl starches with a lower mean molecular weight and molar substitution than the old hydroxyethyl starch may be promising by improving volume management therapy with lower risks of coagulation abnormalities and renal impairment. The selection of colloid for plasma volume expansion should be based on the patients' clinical conditions and the characteristics of each colloid.

Keyword

Fluid therapy; Plasma substitutes; Colloids

MeSH Terms

Colloids
Critical Illness
Critical Care
Dextrans
Dissent and Disputes
Fluid Therapy
Gelatin
Hemodynamics
Hetastarch
Humans
Hypersensitivity
Hypovolemia
Isotonic Solutions
Molar
Molecular Weight
Plasma
Plasma Substitutes
Plasma Volume
Colloids
Dextrans
Gelatin
Hetastarch
Isotonic Solutions
Plasma Substitutes

Reference

1. Boldt J, Suttner S. Plasma substitutes. Minerva Anestesiol. 2005; 71:741–758.

2. Bai SJ, Lee JW, Lee KY. Fluid therapy: classification and characteristics of intravenous fluids. J Korean Med Assoc. 2010; 53:1103–1112.

3. Vaupshas HJ, Levy M. Distribution of saline following acute volume loading: postural effects. Clin Invest Med. 1990; 13:165–177.

4. Imm A, Carlson RW. Fluid resuscitation in circulatory shock. Crit Care Clin. 1993; 9:313–333.

5. Schortgen F, Deye N, Brochard L. CRYCO Study Group. Preferred plasma volume expanders for critically ill patients: results of an international survey. Intensive Care Med. 2004; 30:2222–2229.

6. Caraceni P, Domenicali M, Tovoli A, Napoli L, Ricci CS, Tufoni M, Bernardi M. Clinical indications for the albumin use: still a controversial issue. Eur J Intern Med. 2013; 06. 20. [Epub]. DOI: 10.1016/j.ejim.2013.05.015.

7. Soni N, Margarson M. Use and abuse of albumin in clinical practice. Anasthesiol Intensivmed Notfallmed Schmerzther. 1999; 34:784–788.

8. Garcia-Martinez R, Caraceni P, Bernardi M, Gines P, Arroyo V, Jalan R. Albumin: Pathophysiologic basis of its role in the treatment of cirrhosis and its complications. Hepatology. 2013; 02. 19. [Epub]. DOI: 10.1002/hep.26338.

9. De Gaudio AR. Therapeutic use of albumin. Int J Artif Organs. 1995; 18:216–224.

10. Guthrie RD Jr, Hines C Jr. Use of intravenous albumin in the critically ill patient. Am J Gastroenterol. 1991; 86:255–263.

11. Koppel C, Baudisch H, Ibe K. Inadvertent metal loading of critically ill patients with acute renal failure by human albumin solution infusion therapy. J Toxicol Clin Toxicol. 1988; 26:337–356.

12. Alving BM, Hojima Y, Pisano JJ, Mason BL, Buckingham RE Jr, Mozen MM, Finlayson JS. Hypotension associated with prekallikrein activator (Hageman-factor fragments) in plasma protein fraction. N Engl J Med. 1978; 299:66–70.

13. Finfer S, Bellomo R, Boyce N, French J, Myburgh J, Norton R. SAFE Study Investigators. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med. 2004; 350:2247–2256.

14. De Jonge E, Levi M. Effects of different plasma substitutes on blood coagulation: a comparative review. Crit Care Med. 2001; 29:1261–1267.

15. Raghunath V, Marshall G, Ratanjee SK, Francis RS. Transient massive proteinuria after gelatin-derived plasma expander (Gelofusine®) administration. Nephrology (Carlton). 2013; 18:240–241.

16. Kathirvel S, Podder S, Batra YK, Malhotra N, Mahajan R. Severe life threatening reaction to Haemaccel in a patient with bronchial asthma. Eur J Anaesthesiol. 2001; 18:122–123.

17. Menger MD, Sack FU, Hammersen F, Messmer K. Tissue oxygenation after prolonged ischemia in skeletal muscle: therapeutic effect of prophylactic isovolemic hemodilution. Adv Exp Med Biol. 1989; 248:387–395.

18. Lee J. Plasma volume expanders and intraoperative fluid therapy. Korean J Anesthesiol. 2009; 56:483–491.

19. Jungheinrich C, Neff TA. Pharmacokinetics of hydroxyethyl starch. Clin Pharmacokinet. 2005; 44:681–699.

20. Boldt J. Modern rapidly degradable hydroxyethyl starches: current concepts. Anesth Analg. 2009; 108:1574–1582.

21. Haisch G, Boldt J, Krebs C, Suttner S, Lehmann A, Isgro F. Influence of a new hydroxyethylstarch preparation (HES 130/0.4) on coagulation in cardiac surgical patients. J Cardiothorac Vasc Anesth. 2001; 15:316–321.

22. Kim KO, Han SS, Kim CS. Effects of intravascular volume therapy with a hydroxyethyl starch (HES 130/0.4) on blood coagulation in children undergoing cardiac surgery. Korean J Anesthesiol. 2004; 47:379–384.

23. Na S, Nam SB, Kim DH, Shim JK, Yang HG, Kwak YL. Effect of preoperative volume loading with new hydroxyethyl starch (6% HES 130/0.4) in patients undergoing off-pump coronary artery bypass graft surgery. Korean J Anesthesiol. 2006; 51:669–674.

24. Wilkes MM, Navickis RJ, Sibbald WJ. Albumin versus hydroxyethyl starch in cardiopulmonary bypass surgery: a meta-analysis of postoperative bleeding. Ann Thorac Surg. 2001; 72:527–533.

25. Treib J, Baron JF, Grauer MT, Strauss RG. An international view of hydroxyethyl starches. Intensive Care Med. 1999; 25:258–268.

26. Wiedermann CJ, Dunzendorfer S, Gaioni LU, Zaraca F, Joannidis M. Hyperoncotic colloids and acute kidney injury: a meta-analysis of randomized trials. Crit Care. 2010; 14:R191.

27. Boussekey N, Darmon R, Langlois J, Alfandari S, Devos P, Meybeck A, Chiche A, Georges H, Leroy O. Resuscitation with low volume hydroxyethylstarch 130 kDa/0.4 is not associated with acute kidney injury. Crit Care. 2010; 14:R40.

28. Hartog CS, Bauer M, Reinhart K. The efficacy and safety of colloid resuscitation in the critically ill. Anesth Analg. 2011; 112:156–164.