The crystalloid‐colloid debate: Consequences of resuscitation fluid selection in veterinary critical care

Abstract

Clinical data from critically ill human patients have failed to demonstrate an outcome advantage associated with colloidal fluid resuscitation and indicate that hydroxyethyl starch solutions may be associated with significant adverse effects, including acute kidney injury, need for renal replacement therapy, coagulopathies, and pathologic tissue uptake. The ability to apply these findings to veterinary patients is unknown; however, similar pathophysiology may apply, and critical re-evaluation of resuscitation strategies is justified.

Retrospective evaluation of the effects of administration of tetrastarch (hydroxyethyl starch 130/0.4) on plasma creatinine concentration in dogs (2010–2013): 201 dogs

“…A few experimental studies have documented HES deposition in canine tissues, including the kidneys, but an association with clinically relevant sequelae has thus far not been evaluated . Other proposed mechanisms of HES‐related renal impairment include interstitial macrophage infiltration and “hyperoncotic AKI,” with the latter one being largely debated . However, the degree of contribution of each mechanism and more importantly the relationship between morphological and functional changes have not been fully elucidated …”

“…Hydroxyethyl starch (HES) solutions have been widely used as volume expanders in critically ill human and veterinary patients. Since their introduction on the market in the 1970s, their benefit over crystalloids (CRYSs) has been a source of ongoing debate . Despite their known side effects, such as coagulopathies, kidney injury, and tissue storage, HES solutions have remained the most commonly used resuscitation fluids for human patients in many countries .…”

Perioperative Blood Pressure Control and Management

“…Most colloids should not be given at doses of greater than 20 mL/kg in a 24-hour period to avoid hemodilution and coagulopathy. 25 …”

Bacterial translocation in critical illness

“…The main goals in attempting to limit BT in critical illness include maintaining intestinal perfusion to limit IR injury and ensuring the continuity of the epithelial barrier and mucus layer. Intravenous crystalloids, colloids and vasopressors should be used to ensure an effective circulating volume and adequate end-organ perfusion (Cazzoli & Prittie 2015 ). Judicious fluid administration should be performed to limit the gut wall Journal of Small Animal Practice • Vol 58 • April 2017 • © 2017 British Small Animal Veterinary Association oedema and ileus (Shah et al .…”

“…2014 ). The use of crystalloids versus colloids is controversial because human studies have shown a lack of superior outcome with the use of artificial colloids (Cazzoli & Prittie 2015 ). Hetastarch has the potential to cause acute kidney injury, thought to be due to the accumulation of lysosomes in the proximal tubule from pinocytosis of the colloid particles, leading to tubular swelling and interstitial inflammation (Hayes et al .…”