Colloid IV fluids

[Norbi]

What do you guys think about HAES? From what I've read on here, medics in the states use NS and LR only.Do you want HAES? Is it worth it in the prehospital field?

 

[chaz90]

I don't know a ton about HAES, but I believe it was shown to increase risk of renal failure, dialysis, and overall mortality. Unless there is new research I don't know about, it sounds like another one of those things that is good in theory (Yay, more intravascular fluid) but doesn't work well in practice considering its physiological sequelae.

 

[Norbi]

Not to mention it causes intense itching in some cases(for up to a year!)...but yeah, it seems to be nice in the short term by pulling extravasal fluid into the vasculature, and improving perfusion, but those long term problems you mentioned are quite nasty.

In Hungary HAES is stocked on ALS vans for trauma, and I've seen it in the ICU for all sorts of patients who had nothing to do with trauma.And we're supposed to be proud of our medical prowess...:glare: but i'm just a medic student, those ICU doctors surely know a bit more about the stuff

 

[Arovetli]

There has been a bunch of stuff published this year so far about it.

None of it really says much other than what we already know, it doesn't appear to significantly effect certain end points and there are some important side effects.

The jury is still out I guess you could say, but I don't see any indication that it is worth putting out there in the field at this point.

 

[Smash]

Not to mention it causes intense itching in some cases(for up to a year!)...but yeah, it seems to be nice in the short term by pulling extravasal fluid into the vasculature, and improving perfusion, but those long term problems you mentioned are quite nasty.

In Hungary HAES is stocked on ALS vans for trauma, and I've seen it in the ICU for all sorts of patients who had nothing to do with trauma.And we're supposed to be proud of our medical prowess...:glare: but i'm just a medic student, those ICU doctors surely know a bit more about the stuff

Maybe they do.... but medical practice depends on many things and scientific data only makes up a small percentage of them.
I'll assume you have access to JAMA, there was a meta-analysis published in January this year called Association of hydroxyethyl starch administration with mortality and acute kidney injury in critically ill patients requiring volume resuscitation: a systematic review and meta-analysis. that chaz will be referring to. Intensivists down here won't touch the stuff.

 

[Smash]

Hetastarch marketing approval suspended in EU as risks outweigh benefits

http://www.ema.europa.eu/ema/index....news_detail_001814.jsp&mid=WC0b01ac058004d5c1

 

[Akulahawk]

The good part about hetastarch is that it does work. It does rob Peter to pay Paul... It's other advantage is that the volume expansion you do get is several times what you infuse... thanks to the hetastarch. Consequently, it's a heck of a lot lighter than the amount of crystalloid you'd have to carry to obtain an equivalent intravascular volume expansion.

Downside: Well, that's already been well covered.

Needless to say, unless I'm someplace where weight is at an absolute premium, I'm not choosing HES for volume expansion. Even if I have to, I'm going to limit the amount I infuse. I just see too much risk in inadvertently causing an intravascular fluid overload problem from infusing too much HES. I think it's much easier to regulate the amount of expansion you get with a crystalloid.

My view on this stuff may be a little dated, but I did generate this viewpoint quite a while ago... like about 10 years ago, which was around the time that it was somewhat popular for certain applications (like military settings... hence the weight statement).

 

[Norbi]

Hetastarch marketing approval suspended in EU as risks outweigh benefits

http://www.ema.europa.eu/ema/index....news_detail_001814.jsp&mid=WC0b01ac058004d5c1[/QUOTE

i just imagined the supreme executive commander of this PRAC browsing around in forums on his off day and finding this thread and thinking "uh oh..." :lol:

Akula, does the military use cristalloid only now?

 

[Akulahawk]

Hetastarch marketing approval suspended in EU as risks outweigh benefits

http://www.ema.europa.eu/ema/index....news_detail_001814.jsp&mid=WC0b01ac058004d5c1[/QUOTE

i just imagined the supreme executive commander of this PRAC browsing around in forums on his off day and finding this thread and thinking "uh oh..." :lol:

Akula, does the military use cristalloid only now?

I can only hope so. However, doing so would mean that the Medics/Docs would have to carry a bit more weight to do so, or wait for something to arrive that doesn't have a weight restriction as far as how many 1000 ml bags of crystalloid that can be stored onboard...

I'm not, nor have I been, a military medic/Corpsman but I certainly do recall that there was quite a bit of hoopla about using colloids (hespan) for volume replacement because of the expansion it garnered for the volume infused, along with a significant weight savings for the folks carrying IV fluids around. I also seem to recall that they'd limit the number of bags to be infused before switching over to crystalloids or (hopefully) getting the wounded person to a facility where blood could be transfused instead. It seemed that ONE of the reasons for limiting colloid amounts was that the amount of volume expansion was a bit, shall we say, unpredictable. It would not be nice to have someone start with 80/50 BP, then go to 110/70 a short while after colloids are given, and start popping clots along the way... thus actually increasing hemorrhage. Another person might have a smaller increase in BP and be OK...