Colloidal Volume Replacement Therapy: UNI-MED SCIENCE

1. Fundamentals 14 1.1. Plasma expanders - definition 14 1.1.1. Review 14 1.1.2. Compartments 14 1.1.3. Volume effect 14 1.1.4. Application to clinical practice 15 1.1.5. References 15 1.2. Pharmacological fundamentals and mechanisms of action 16 1.2.1. Fluid spaces of the body and their regulation 16 1.2.2. Intravascular and interstitial space and fluid exchange between them via the capillary wall 17 1.2.3. Colloidal volume substitutes 17 1.2.4. Colloid osmotic pressure, ability to bind water 18 1.2.5. Viscosity 18 1.2.6. Side effects 19 1.2.7. References 20 1.3. Colloids in the treatment of hypovolaemic states intraoperatively 20 1.3.1. Physiological basis 20 1.3.2. Differential indication of the product classes 23 1.3.3. Summary and outlook 24 1.3.4. References 24 1.4. Monitoring of volume therapy 25 1.4.1. Preload 25 1.4.2. Possibilities for regulation 26 1.4.3. References 30 2. Currently available synthetic colloids and their indications 32 2.1. Hydroxyethyl starch (HES) 32 2.1.1. Structure and physiology of hydroxyethyl starch 32 2.1.2. Conclusion 33 2.1.3. References 34 2.2. Gelatin 34 2.2.1. Volume effect 34 2.2.2. Inflammation and microcirculation 35 2.2.3. Risk of infection 35 2.2.4. Gelatin and renal function 35 2.2.5. Coagulation effects 35 2.2.6. Intolerance reactions 35 2.2.7. References 36 2.3. Dextrans and Albumin 36 2.3.1. Dextrans 36 2.3.1.1. Structure, history and pharmacology 36 2.3.1.2. Theoretical advantages 37 2.3.1.3. Disadvantages 37 2.3.1.4. Conclusions 38 2.3.1.5. References 38 2.3.2. Albumin 39 2.3.2.1. Structure, history and physiology 39 2.3.2.2. Advantages 39 2.3.2.3. Disadvantages 39 2.3.2.4. Albumin in intensive care patients 40 2.3.2.5. Albumin in burns 40 2.3.2.6. Correction of hypoalbuminaemia 40 2.3.2.7. Conclusions 41 2.3.2.8. References 41 2.4. Use of hypertonic, hyperoncotic solution in trauma patients 42 2.4.1. Composition of hypertonic and hypertonic, hyperoncotic solutions 42 2.4.2. Mechanisms of action of hypertonic and hypertonic, hyperoncotic solutions 43 2.4.3. Side effects 43 2.4.4. Preclinical and clinical studies 44 2.4.5. Summary 45 2.4.6. References 46 3. Therapeutic practice 48 3.1. Use in renal replacement therapy and renal dysfunction 48 3.1.1. Pathophysiology 48 3.1.2. Pharmacokinetics 49 3.1.3. Perioperative situation 49 3.1.4. Sepsis 50 3.1.5. Summary 51 3.1.6. References 51 3.2. Side effects on coagulation 52 3.2.1. Inhibition of plasmatic coagulation 52 3.2.2. Effect on fibrinolysis 53 3.2.3. Inhibition of platelet function 53 3.2.4. Reversal 53 3.2.5. Comparison of synthetic colloids 54 3.2.6. New preparations and coagulation 54 3.2.7. Coagulation and perioperative bleeding 54 3.2.8. Postoperative hypercoagulability 54 3.2.9. Summary for clinical practice 54 3.2.10. References 55 3.3. Use of colloids in septic patients 55 3.3.1. Randomised studies on volume therapy in sepsis 56 3.3.2. Macro- and microcirculation 57 3.3.3. Summary 57 3.3.4. References 57 3.4. Utility and safety of colloids in adult and paediatric cardiac surgery 58 3.4.1. Evidence in the adult population 59 3.4.2. The paediatric population 59 3.4.3. The future 61 3.4.4. Summary 61 3.4.5. References 61 3.5. Volume therapy for caesarean delivery under spinal anaesthesia 62 3.5.1. Crystalloids 63 3.5.2. Colloids vs crystalloids 63 3.5.3. Colloids - advantages/disadvantages of different product classes 63 3.5.4. Experiences with modern colloids 64 3.5.5. Conclusions 64 3.5.6. References 64 Index 68