RESUMEN
This update aims to provide an evidence based review of natural and synthetic colloids with a special emphasis on the various generations of the synthetic colloid hydroxyethyl starch. The effect of 1(st), 2(nd) and 3(rd) generation hetastarches on bleeding, coagulopathy, acute kidney injury and mortality will be discussed. The results of randomised controlled trials addressing morbidity and mortality outcomes of colloid versus crystalloid resuscitation in critically ill patients will be described. In addition, the rationale and evidence behind early goal directed fluid therapy (EGDFT) including a practical approach to assessment of dynamic measures of fluid responsiveness will be presented.
Asunto(s)
Fluidoterapia , Derivados de Hidroxietil Almidón/uso terapéutico , Sustitutos del Plasma/uso terapéutico , Resucitación/métodos , Choque/terapia , Animales , Coloides , Cuidados Críticos , Enfermedad Crítica , Soluciones Cristaloides , Fluidoterapia/efectos adversos , Fluidoterapia/mortalidad , Hemodinámica , Humanos , Derivados de Hidroxietil Almidón/efectos adversos , Derivados de Hidroxietil Almidón/análogos & derivados , Derivados de Hidroxietil Almidón/clasificación , Soluciones Isotónicas/uso terapéutico , Atención Perioperativa , Sustitutos del Plasma/efectos adversos , Sustitutos del Plasma/clasificación , Resucitación/efectos adversos , Resucitación/mortalidad , Choque/mortalidad , Choque/fisiopatología , Resultado del TratamientoAsunto(s)
Coloides/uso terapéutico , Sustitutos del Plasma/uso terapéutico , Soluciones para Rehidratación/uso terapéutico , Coloides/química , Coloides/clasificación , Soluciones Cristaloides , Fluidoterapia , Humanos , Derivados de Hidroxietil Almidón/química , Derivados de Hidroxietil Almidón/clasificación , Derivados de Hidroxietil Almidón/uso terapéutico , Soluciones Isotónicas , Peso Molecular , Sustitutos del Plasma/química , Sustitutos del Plasma/clasificación , Soluciones para Rehidratación/química , Soluciones para Rehidratación/clasificaciónRESUMEN
OBJECTIVE: to compare diafiltered 6% pentastarch (Pentafraction--PDP, MWn 120,000 and MWw 280,000) and native pentastarch (Pentaspan--PSP, MWn 63,000 and MWw 264,000 dalton) in a porcine model of faecal peritonitis. DESIGN: Randomised prospective study in 12 adolescent pigs. INTERVENTIONS: Prior to infection the study solution was infused to increase Qt by 25%. Thereafter adjustments in infusion rate were made (up to 1 l/h) in an attempt to maintain Qt at 25% above baseline values. MEASUREMENTS AND RESULTS: Animals were sacrificed at 8 h. Tissue was excised from the right lobe of liver and from the right lung and fixed for later electron microscopy and digital morphometric analysis. Patent sinusoidal lumen was significantly greater in group PDP compared to PSP (11.3% +/- 2.3% of liver tissue versus 4.8% +/- 1.1%, p < 0.05) and this was accounted for by a significantly lower proportion of sinusoidal lumen occluded with white cells (2.1% +/- 0.6% versus 6.6% +/- 1.9%, p < 0.05). Similarly, patent capillary represented a significantly higher proportion of lung tissue for group PDP versus PSP (26.2% +/- 1.9% versus 18.5% +/- 2.7%, p < 0.05). The arithmetic mean alveolar capillary barrier thickness was significantly greater in group PSP than in group PDP (4.3 +/- 0.3 microns versus 2.5 +/- 0.3 microns, p < 0.01). CONCLUSIONS: The molecular weight profile of Pentafraction was associated with less structural organ damage including less tissue oedema and less white cell occlusion.