Effects of hydroxyethyl starch after trauma-hemorrhagic shock

Schmand, J.; Ayala, Alfred; Morrison, Mary H.; Chaudry, Irshad H.

doi:10.1097/00003246-199505000-00006

Cited by 69 publications

(3 citation statements)

References 34 publications

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“…When used at reasonable concentrations, HES is free of side effects and appears to be less toxic than DMSO [16–19]. There are several publications that illustrate the use of HES in cell cryopreservation.…”

Section: Introductionmentioning

confidence: 99%

Cryopreservation of dermal fibroblasts and keratinocytes in hydroxyethyl starch–based cryoprotectants

et al. 2016

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BackgroundPreservation of human skin fibroblasts and keratinocytes is essential for the creation of skin tissue banks. For successful cryopreservation of cells, selection of an appropriate cryoprotectant agent (CPA) is imperative. The aim of this study was to identify CPAs that minimize toxic effects and allow for the preservation of human fibroblasts and keratinocytes in suspension and in monolayers.ResultsWe cryopreserved human fibroblasts and keratinocytes with different CPAs and compared them to fresh, unfrozen cells. Cells were frozen in the presence and absence of hydroxyethyl starch (HES) or dimethyl sulfoxide (DMSO), the latter of which is a commonly used CPA known to exert toxic effects on cells. Cell numbers were counted immediately post-thaw as well as three days after thawing. Cellular structures were analyzed and counted by labeling nuclei, mitochondria, and actin filaments. We found that successful cryopreservation of suspended or adherent keratinocytes can be accomplished with a 10% HES or a 5% HES, 5% DMSO solution. Cell viability of fibroblasts cryopreserved in suspension was maintained with 10% HES or 5% HES, 5% DMSO solutions. Adherent, cryopreserved fibroblasts were successfully maintained with a 5% HES, 5% DMSO solution.ConclusionWe conclude that skin tissue cells can be effectively cryopreserved by substituting all or a portion of DMSO with HES. Given that DMSO is the most commonly used CPA and is believed to be more toxic than HES, these findings are of clinical significance for tissue-based replacement therapies. Therapies that require the use of keratinocyte and fibroblast cells, such as those aimed at treating skin wounds or skin burns, may be optimized by substituting a portion or all of DMSO with HES during cryopreservation protocols.

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Section: Introductionmentioning

confidence: 99%

Cryopreservation of dermal fibroblasts and keratinocytes in hydroxyethyl starch–based cryoprotectants

et al. 2016

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“…However, there have also been some reported benefits of 6% HES, including its ability to suppress nuclear factor κB activation (60), restore the balance between antiapoptotic and proapoptotic proteins (60), restore macrophage release of IL-6 (61), and decrease neutrophil tethering to and migration across the endothelium (62). The results with dextran solutions have been similarly mixed in animal models, depending on its concentration and molecular size.…”

Section: Present Knowledge Of the Immunologic And Circulatory Sciencementioning

confidence: 99%

Fluid Resuscitation

Santry

Alam

2010

Shock

215

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Hemorrhage remains a major cause of preventable death following both civilian and military trauma. The goals of resuscitation in the face of hemorrhagic shock are restoring end-organ perfusion and maintaining tissue oxygenation while attempting definitive control of bleeding. However, if not performed properly, resuscitation can actually exacerbate cellular injury caused by hemorrhagic shock, and the type of fluid used for resuscitation plays an important role in this injury pattern. This article reviews the historical development and scientific underpinnings of modern resuscitation techniques. We summarized data from a number of studies to illustrate the differential effects of commonly used resuscitation fluids, including isotonic crystalloids, natural and artificial colloids, hypertonic and hyperoncotic solutions, and artificial oxygen carriers, on cellular injury and how these relate to clinical practice. The data reveal that a uniformly safe, effective, and practical resuscitation fluid when blood products are unavailable and direct hemorrhage control is delayed has been elusive. Yet, it is logical to prevent this cellular injury through wiser resuscitation strategies than attempting immunomodulation after the damage has already occurred. Thus, we describe how some novel resuscitation strategies aimed at preventing or ameliorating cellular injury may become clinically available in the future.

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“…However, large volume crystalloid resuscitation has been shown to be associated with cardiac, pulmonary and coagulopathic complications that occur secondary to the cellular and metabolic disturbances associated with crystalloid use following hemorrhage. 15,16 Although there are significant risks associated with crystalloid use, it remains common, especially in the early resuscitation of the hemorrhaging trauma patient. Despite its near ubiquitous use, the role of crystalloid in massive transfusion protocols and the outcomes of massive transfusion patients receiving crystalloid infusion have not been thoroughly characterized.…”

Section: Introductionmentioning

confidence: 99%

Crystalloid to packed red blood cell transfusion ratio in the massively transfused patient

Neal

Hoffman

Cuschieri

et al. 2012

Journal of Trauma and Acute Care Surgery

116

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Objective Massive transfusion protocols have emphasized the importance of ratio-based transfusion of plasma and platelets relative to packed red blood cells (PRBCs), however the risks attributable to crystalloid resuscitation in patients requiring massive transfusion remain largely unexplored. We hypothesized that an increased crystalloid:PRBC (C:PRBC) ratio would be associated with increased morbidity and poor outcome following massive transfusion. Methods Data were obtained from a multi-center prospective cohort study evaluating outcomes in blunt injured adults with hemorrhagic shock. Patients requiring massive transfusion (≥10u PRBCs in first 24hrs) were analyzed. The C:PRBC ratio was computed by the ratio of crystalloid infused in liters (L) to the units of PRBCs transfused in the first 24hrs post-injury. Logistic regression modeling was used to characterize the independent risks associated with the 24hr C:PRBC ratio, after controlling for important confounders and other blood component transfusion requirements. Results Logistic regression revealed that the 24hr C:PRBC ratio was significantly associated with a greater independent risk of MOF, acute respiratory distress syndrome (ARDS) and abdominal compartment syndrome (ACS). No association with mortality or nosocomial infection was found. A dose response analysis revealed patients with a C:PRBC ratio >1.5:1, had over a 70% higher independent risk of MOF, and over a 2-fold higher risk of ARDS and ACS. Conclusion In patients requiring massive transfusion, crystalloid resuscitation in a ratio greater than 1.5:1 per unit of PRBCs transfused was independently associated with a higher risk of MOF, ARDS, and ACS. These results suggest overly aggressive crystalloid resuscitation should be minimized in these severely injured patients. Further research is required to determine if incorporation of the C:PRBC ratio into massive transfusion protocols improves outcome.

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Effects of hydroxyethyl starch after trauma-hemorrhagic shock

Abstract: Since the use of lactated Ringer's solution and hydroxyethyl starch after hemorrhage did not adversely affect cell-mediated immune functions, but produced salutary effects on macrophage functions, hydroxyethyl starch is a safe and beneficial resuscitation adjunct.

Cited by 69 publications

References 34 publications

Cryopreservation of dermal fibroblasts and keratinocytes in hydroxyethyl starch–based cryoprotectants

Cryopreservation of dermal fibroblasts and keratinocytes in hydroxyethyl starch–based cryoprotectants

Fluid Resuscitation

Crystalloid to packed red blood cell transfusion ratio in the massively transfused patient

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