Effect of perioperative crystalloid or colloid fluid therapy on hemorrhage, coagulation competence, and outcome

Rasmussen, K; Secher, Niels H.; Pedersen, Thomas Bondo

doi:10.1097/md.0000000000004498

Cited by 55 publications

(47 citation statements)

References 55 publications

(133 reference statements)

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“…This and the potential impairment of renal function provide the reason for dose limitation (30 ml/kg). A recently published metaanalysis showed that HES application can result in a larger intraoperative blood loss compared to crystalloid therapy alone [66]. However, it must be noted that larger blood losses are often not appropriately treated by the sole application of crystalloid.…”

Section: Do These Considerations Also Apply To the Use Of Hes Preparamentioning

confidence: 99%

State of the art in fluid and volume therapy

et al. 2017

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Section: Do These Considerations Also Apply To the Use Of Hes Preparamentioning

confidence: 99%

State of the art in fluid and volume therapy

et al. 2017

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“…However, synthetic colloid administration is associated with coagulopathy and increases the need for red blood cells transfusion, as was consistently shown in large RCTs that compared crystalloids to HES in sepsis and critically ill patients 2 – 4 . Increased risk of bleeding after HES administration was also found in meta-analyses of RCTs in cardiac surgery patients and in the perioperative period 23 , 24 . Furthermore, there is strong evidence for prolonged bleeding times and decrease in clot firmness from in-vitro studies 25 and evidence of increased bleeding and mortality in animal studies 26 – 28 .…”

Section: Discussionmentioning

confidence: 63%

Synthetic colloid resuscitation in severely injured patients: analysis of a nationwide trauma registry (TraumaRegister DGU)

Hilbert-Carius

Schwarzkopf

Reinhart

et al. 2018

Sci Rep

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The purpose of this study was to investigate the efficacy and safety of synthetic colloid resuscitation among severely injured patients. Fluid resuscitation of trauma patients of a nationwide trauma registry was analysed between 2002 and 2015. Effects of synthetic colloid resuscitation in the pre-hospital setting and emergency department on renal failure, renal replacement therapy and multiple organ failure were analysed among patients with ≥2 days intensive care unit stay, and in-hospital mortality was analysed among all patients. 48,484 patients with mean age of 49 years and mean injury severity score of 23 points were included; 72.3% were male and 95.5% had blunt trauma. Risk-adjusted analyses revealed that patients receiving >1,000 ml synthetic colloids experienced an increase of renal failure and renal replacement therapy rates (OR 1.42 and 1.32, respectively, both p ≤ 0.006). Any synthetic colloid use was associated with an increased risk of multiple organ failure (p < 0.001), but there was no effect on hospital mortality (p = 0.594). Between 2002 and 2015 usage of synthetic colloids dropped, likewise did total fluid intake and usage of blood products. The data from this analysis suggests that synthetic colloid resuscitation provides no beneficial effects and might be harmful in patients with severe trauma.

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“…Additionally, our results are in accordance with a metaanalysis published by Rasmussen. 37 Patients in group RA-HES received significantly more crystalloids than patients in group RA (Table 3). This can be explained by the increased blood loss experienced by patients in group RA-HES, which was not fully compensated by the administration of HES and PRBC.…”

Section: Discussionmentioning

confidence: 98%