Voluven, A New Colloid Solution

Abstract

A variety of fluid solutions can be used as intravascular replacement for surgical volume loss, and to avoid or delay blood transfusions. Crystalloid solutions, such as Ringer lactate, are typically administered at a rate of 3 or 4 times the volume of blood loss caused by continuous rapid extravasations. Approximately 20% of the volume initially administered remains in the intravascular space hours later. Therefore, rapid infusion of large amounts of crystalloid solutions can cause problems in elderly patients with limited cardiovascular reserve, and can lead to pulmonary and systemic edema. Alternatively, a commonly used synthetic colloid, hydroxyethyl starch (HES), readily allows for a 1:1 replacement ratio of intravascular volume to shed blood, and remains in the intravascular space longer compared with crystalloid solutions. However, HES can induce coagulopathy during prolonged surgical procedures because of the reduced release of factor VIII, von Willebrand Factor (vWF), and impaired platelet function.There are many types of HES according to molecular weight (MW) and degree of substitution (DS). In general, HES with a low MW and low DS is preferred because HES solutions with a high MW and high DS are harder to metabolize and eliminate from the intravascular space. This prolonged stay results in extended adverse effects on coagulation. Six percent HES with a MW of 130 kDa and a DS of 0.4 in a saline medium (Voluven, Fresenius Kabi, Germany) has the lowest MW/DS ratio among other HES on the market and therefore is purported to induce less coagulation impairment. This review of crystalloid and colloid fluid replacement alternatives explores recently published evidence of the clinical utility of Voluven.

Choice of Fluids in Severe Septic Patients - A Cost-effectiveness Analysis Informed by Recent Clinical Trials

“…We acknowledge that the key assumption that the three modalities studied are biopharmaceutically equivalent within a class is contentious, but we note that this assumption underpins all the systematic reviews pertaining to these products. This issue is most contentious in relation to hydroxyethyl starch, where the relative safety of recent formulations has been emphasized [14], but we note the conclusions of a recent NIH/FDA workshop that over a longer period of time hydroxyethyl starch has been associated with serious adverse events in sepsis irrespective of the formulation used [35], conclusions which underpin the recent regulatory decisions worldwide to restrict access to these products [36,43]. Finally, we recognize the limitations imposed by the paucity of head to head trials between albumin and HES, necessitating the hypothetical comparison proposed in the model.…”

“…Over the past decade, a number of hydroxyethyl starch products with an average molecular weight of 130 kD and a degree of substitution of 0.4 (low molecular weight (LMW) hydroxyethyl starch) have been introduced into therapeutic practice. These properties are claimed to ameliorate or obviate the haemostatic and renal adverse events [14]. Recent meta-analyses do not support these claims [15,16], and have led authorities in the United States and Europe to place restrictions on the use of these drugs.…”

Beneficial effects of elevating cardiac preload on left-ventricular diastolic function and volume during heat stress: implications toward tolerance during a hemorrhagic insult

“…The total duration of the infusions was ϳ10 min. A hydroxyethyl starch solution was used to maximize plasma volume replacement given that colloids remain in the vascular space for an appreciably longer duration (Voluven range is 4 -6 h) than saline alone (24). This solution was also selected over Dextran, which we previously used (18), given the lower risk for an anaphylactic reaction with hydroxyethyl starch (14).…”

Mashed Potatoes and Maize

“…Older generations of HES with substitution ratios of 0.5, 0.6, and 0.7 are known as penta-, hexa-, and hetastarches, respectively. 8 Newer generation tetrastarches are derived from two sources. The raw material is either waxy maize starch in 6% HES 130/0.4 (Voluven® or Volulyte®, Fresenius Kabi, Bad Homburg, germany) or potato starch in 6% HES 130/0.42 (e.g., Venofundin® or tetraspan®, B. Braun Melsungen, germany; VitaHES® or Vitafusal®, Serumwerk Bernburg, germany; PlasmaVolumeRedibag®, Baxter, Unterschleißheim, germany), and some including Martin et al 7 believe that maize-and potatoderived 6% HES 130 are not biologically equivalent.…”