Hydroxyethylstarch 200/0.5 - the horse has bolted
نویسنده
چکیده
Hydroxyethylstarch (HES) 200/0.5 is associated with renal failure. Several studies have suggested that renal function is affected but the subsequent arguments leave the clinician in no man's land. A recent study in Critical Care by Simon and colleagues using a two hit animal model of shock demonstrates that the use of a higher molecular weight starch, HES 200/0.5, is associated with impaired renal function when compared with ringers acetate, gelatin or a lower molecular weight starch, HES 130/0.42. The authors conclude that both the lower molecular weight starch and the ringers acetate 'preserve renal function and attenuate tubular damage better than 10% hydroxyethylstarch 200/0.5 in saline'. Added to the previous evidence, the renal effects of HES200/0.5 are probably real. Many clinicians have already moved to the lower molecular weight starches on the basis of doubt rather than certainty, but this study tips the balance. The cause remains elusive and the lack of a mechanism should be seen as a problem.
منابع مشابه
Hydroxyethylstarch impairs renal function and induces interstitial proliferation, macrophage infiltration and tubular damage in an isolated renal perfusion model
INTRODUCTION The aim of the study was to evaluate some of the underlying pathomechanisms of hydroxyethylstarch (HES) induced adverse effects on renal function using 24 porcine kidneys in an isolated perfusion model over six hours. METHODS Infusion of either 10% HES 200/0.5, 6% HES 130/0.42 or Ringer's lactate (RL) was performed to achieve an haematocrit of 20% in eight kidneys from four anima...
متن کاملImpairment of renal function using hyperoncotic colloids in a two hit model of shock: a prospective randomized study
INTRODUCTION One of the therapeutic essentials in severe sepsis and septic shock is an adequate fluid replacement to restore and maintain circulating plasma volume, improve organ perfusion and nutritive microcirculatory flow. The type of solution to be used as a fluid replacement remains under discussion. The aim of the study was to evaluate the effects of clinically used fluid replacement solu...
متن کاملInfluential Factor in Improving the Seismic Performance of the Kaiser Bolted Bracket Moment Connection
Following the Northridge earthquake of 1994, a significant number of steel moment resisting structural systems were damaged. Several studies have been conducted to improve the seismic performance of steel structures and specially their beam-to-column connections. One of the proposed connections for special moment-resisting frames included AISC-358 is Kaiser bolted bracket moment connection, bri...
متن کامل