Abstract
Colloid solutions, both natural and synthetic, had been widely accepted as having superior volume expanding effects than crystalloids. Synthetic colloid solutions were previously considered at least as effective as natural colloids, as well as being cheaper and easily available. As a result, synthetic colloids (and HES in particular) were the preferred resuscitation fluid in many countries. In the past decade, several cascading events have called into question their efficacy and revealed their harmful effects. In 2013, the medicines authorities placed substantial restrictions on HES administration in people which has resulted in an overall decrease in their use. Whether natural colloids (such as albumin-containing solutions) should replace synthetic colloids remains inconclusive based on the current evidence. Albumin seems to be safer than synthetic colloids in people, but clear evidence of a positive effect on survival is still lacking. Furthermore, species-specific albumin is not widely available, while xenotransfusions with human serum albumin have known side effects. Veterinary data on the safety and efficacy of synthetic and natural colloids is limited to mostly retrospective evaluations or experimental studies with small numbers of patients (mainly dogs). Large, prospective, randomized, long-term outcome-oriented studies are lacking. This review focuses on advantages and disadvantages of synthetic and natural colloids in veterinary medicine. Adopting human guidelines is weighed against the particularities of our specific patient populations, including the risk–benefit ratio and lack of alternatives available in human medicine.
Highlights
A colloid is the collective term for electrolyte solutions containing macromolecules, a portion of which cannot pass freely out of the healthy intravascular space
Acute Kidney Injury and Mortality The presumed beneficial effects of hydroxyethyl starches (HES) and the development of modern and putatively safer HES preparations seemed to outweigh the described adverse effects for a long time. This changed after the results of large multicenter randomized controlled trials (RCTs) in people, which compared HES and crystalloids for resuscitation of critically ill patients
In four retrospective studies in critically ill dogs and cats, 6% HES 130/0.4 was not associated with an increased risk for acute kidney injury (AKI) [98,99,100,101], the number of HES days was significantly associated with an increase in AKI grade within 10 days post-HES [98]
Summary
A colloid is the collective term for electrolyte solutions containing macromolecules, a portion of which cannot pass freely out of the healthy intravascular space. The proposed cause for this discrepancy is the damage to the EG resulting in fluid extravasation of both crystalloids and colloids, and similar volume effects [2]. Several experimental hyper- and normovolemic hemodilution models have shown similar findings, whether by evaluating volume expansion or using resuscitation endpoints [26,27,28] These findings contrast with the revised Starling principle, whereby in the transient state of decreased hydrostatic pressure, both crystalloids and colloids should be able to restore blood volume [10]. The cause for these discrepant findings is probably multifactorial. They cannot be used interchangeably in the hypoalbuminemic patient
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