HPE Human Albumin | Page 6

TABLE 1
Composition of some commonly used intravenous fluids 1 , 27
Fluid Sodium ( mmol / l ) Potassium ( mmol / l ) Chloride ( mmol / l ) Osmolarity ( mOsm / kg )
Plasma 140 4.5 103 288
Sodium chloride 0.9 % 154 0 154 308
Lactated Ringers 130 4 111 279
Plasmalyte 140 5 98 N / A
is only a transient increase in the intravascular volume because of the rapid transfer across capillary membranes and ultimate equilibration within the entire extracellular fluid space . Thus , fluid replacement with crystalloids is associated with an increased level of tissue hydration and the risk of edema , in particular , increased extravascular lung water and peripheral tissue edema . 30 A further recognized problem , particularly following prolonged administration of supraphysiological amounts of sodium and chloride , for instance , normal saline , is the risk of hyperchloremic acidosis 31 and which causes a detrimental effect on renal function . 32 This effect can be eliminated through the use of a more physiologically balanced (‘ buffered ’) crystalloid intravenous fluid regimen and which contains less chloride . 33
Colloid or crystalloid ? Whether a crystalloid or colloid represents the optimal IV fluid is yet to determined . However , one factor which has become clear is that in the US , the US FDA has warned against the use of HES products in critically ill patients , including those with sepsis . 34 In a 2019 review of 55 studies including approximately 27,000 patients that compared crystalloids with colloids as a resuscitation fluid in an intensive care setting , the authors concluded that treatment with albumin was associated with a significantly higher cardiac index and central venous pressure ( compared with crystalloids ) at all time points . 35 All cause mortality and 90-day mortality were significantly lower for crystalloids compared with HES . In a follow-up correspondence to the study , the authors suggested that albumin should be more widely considered as an alternative to crystalloid in the intensive care unit . 36
Conclusion In the absence of definitive evidence of superiority , it seems sensible to adopt a balanced fluid regimen approach , incorporating a combination of crystalloids and colloids , that involves tailoring fluid therapy to meet the individual patients ’ requirements , taking account of their clinical condition and avoiding excessive fluid and electrolyte administration and the subsequent effects on morbidity and mortality .
References 1 MacDonald N , Pearse B . Are we close to the ideal intravenous fluid ? BJA 2017 ; 119 : i63-i71 . 2 Mitra S , Khandawal P . Are all colloids the same ? How to select the right colloid ? Indian J Anaesth 2009 ; 53:592 . 3 Datta R et al . Hydroxyethyl starch : controversies revisited . J Anaesthesiol Clin Pharmacol 2014 ; 30 ( 4 ): 472 – 80 . 4 Westphal M et al . Hydroxyethyl starches : different products – different effects . Anaesthesiology 2009 ; 111 ( 1 ): 187 – 202 . 5 Hartog CS et al . Concerns over use of hydroxyethyl starch solutions . BMJ 2014 ; 349 : g5981 6 Alexander B et al . Coagulation , hemostasis , and plasma expanders : a quarter century enigma . Fed Proc 1975 ; 34 ( 6 ): 1429 – 40 . 7 Bellmann R , Feistritzer C , Wiedermann C . Effect of molecular weight and substitution on tissue uptake of hydroxyethyl starch : a metaanalysis of clinical studies . Clin Pharmacokinet 2012 ; 51 ( 4 ): 225 – 36 . 8 Hartog CS , Kohl M , Reinhart K . A systematic review of thirdgeneration hydroxyethyl starch ( HES 130 / 0.4 ) in resuscitation : safety not adequately addressed . Anesth Analg 2011 ; 112 ( 3 ): 635 – 45 .
9 Brunkhorst FM et al . Intensive insulin therapy and pentastarch resuscitation in severe sepsis . N Engl J Med 2008 ; 358:125 – 39 . 10 Zarychanski R et al . Association of hydroxyethyl starch administration with mortality and acute kidney injury in critically ill patients requiring volume resuscitation : a systematic review and meta-analysis . JAMA 2013 ; 309:678 – 88 . 11 Finfer S et al . Resuscitation fluid use in critically ill adults : an international cross-sectional study in 391 intensive care units . Crit Care 2010 ; 14 ( 5 ): R185 . 12 Hammond NE et al . Patterns of intravenous fluid resuscitation use in adult intensive care patients between 2007 and 2014 : an international crosssectional study . PLoS ONE 2017 ; 12 ( 5 ): e0176292 . 13 Perner A et al . Hydroxyethyl starch 130 / 0.42 versus Ringer ’ s acetate in severe sepsis . N Engl J Med 2012 ; 367 ( 2 ): 124 – 34 . 14 Myburgh JA et al . Hydroxyethyl starch or saline for fluid resuscitation in intensive care . N Engl J Med 2012:367:1901 – 11 . 15 Mutter TC , Ruth CA , Dart AB . Hydroxyethyl starch ( HES ) versus other fluid therapies : effects on kidney function . Cochrane Database Syst Rev 2013 ; 7 : CD007594 . 16 Gattas DJ et al . Fluid
resuscitation with 6 % hydroxyethyl starch ( 130 / 0.40 and 130 / 0.42 ) in acutely ill patients : systematic review of effects on mortality and treatment with renal replacement therapy . Intensive Care Med 2013 ; 39 ( 4 ): 558 – 68 . 17 Haase N et al . Hydroxyethyl starch 130 / 0.38- 0.45 versus crystalloid or albumin in patients with sepsis : systematic review with meta-analysis and trial sequential analysis . BMJ 2013 ; 346 : f839 . 18 Annane D et al . Effects of fluid resuscitation with colloids vs crystalloids on mortality in critically ill patients presenting with hypovolemic shock : the CRISTAL randomized trial . JAMA 2013 ; 310:1809 – 17 . 19 Van der Linden P et al . Safety of modern starches used during surgery . Anesth Analg 2013 ; 116:35 – 48 . 20 Takala J , Hartog C , Reinhart K . Safety of modern starches used during surgery : misleading conclusions . Anesth Analg [ letter ] 2013 ; 117 ( 2 ): 527 – 8 . 21 Thomas-Rueddel DO et al . Safety of gelatin for volume resuscitation – a systematic review and metaanalysis . Intensive Care Med 2012 ; 38:1134 – 42 . 22 Saw MM , Chandler B , Ho KM . Benefits and risks of using
gelatin solution as a plasma expander for perioperative and critically ill patients : a metaanalysis . Anaesth Intensive Care 2012 ; 40:17 – 32 . 23 Moeller C et al . How safe is gelatin ? A systematic review and meta-analysis of gelatincontaining plasma expanders vs crystalloids and albumin . J Crit Care 2016 ; 35:75 – 83 . 24 Ertmer C , Rehberg S , Van Aken H . Relevance of nonalbumin colloids in intensive care medicine . Best Pract Res Clin Anaesthesiol 2009 ; 23 ( 2 ): 193 . 25 Awad S , Allison SP , Lobo DN . The history of 0.9 % saline . Problems with solutions : drowning in the brine of an inadequate knowledge base . Clin Nutr 2008 ; 27:179 – 88 . 26 Leach R et al . Fluid management knowledge in hospital physicians : “ Greenshoots ” of improvement but still a cause for concern . Clin Med ( Lond ) 2020 ; 20 ( 3 ): e26-e31 . 27 Hoorn E . Intravenous fluids : balancing solutions . J Nephrol 2017 ; 30:485-92 . 28 Semler MW et al . Balanced Crystalloids versus Saline in Critically Ill Adults . N Engl J Med 2018 ; 378 ( 9 ): 829 – 39 . 29 Self W et al . Balanced Crystalloids versus Saline in Noncritically Ill Adults . N Engl J Med 2018 ; 378:819 – 28 .
30 Lewis S et al . Colloids versus crystalloids for fluid resuscitation in critically ill people ( Review ). Cochrane Database Sys Rev 2018 ; Issue 8 . Art . No .: CD000567 . 31 Skellett S et al . Chasing the base deficit : hyperchloremic acidosis following 0.9 % saline . Arch Dis Child 2000 ; 83:514 – 6 . 32 Handy JM , Soni N . Physiological effects of hyperchloremia and acidosis . Br J Anaesth 2008 ; 101 ( 2 ): 141 – 50 . 33 Yunos NM et al . The biochemical effects of restricting chloride-rich fluids in intensive care . Crit Care Med 2011 ; 39 ( 11 ): 2419 – 24 . 34 Wiedermann CJ , Eisendle K . Comparison of hydroxyethyl starch regulatory summaries from the Food and Drug Administration and the European Medicines Agency . J Pharmaceut Policy Pract 2017 ; 10:12 . 35 Martin GS , Bassett P . Crystalloids vs colloids for fluid resuscitation in the intensive care unit : a systemic review and meta-analysis . J Crit Care 2019 ; 50:144 – 54 . 36 Martin GS , Bassett P . Controversial supremacy : are colloids better than crystalloids ? Authors ’ reply . J Crit Care 2020 [ Letter ]; 58:116 – 17 .
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