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Abstract
The use of colloids may impair hemostatic capacity. However, it remains unclear whether this also holds true when colloids are administered in a goal-directed manner. The aim of the present study was to assess the effect of goal-directed fluid management with 6% hydroxyethyl starch 130/0.4 on hemostasis compared to lactated Ringer’s solution in patients undergoing partial hepatectomy. We included 50 patients in this prospective, randomized, controlled trial. According to randomization, patients received boluses of either hydroxyethyl starch or lactated Ringer’s solution within the scope of goal-directed fluid management. Minimum perioperative FIBTEM maximum clot firmness (MCF) served as the primary outcome parameter. Secondary outcome parameters included fibrinogen levels and estimated blood loss. In the hydroxyethyl starch (HES) group the minimum FIBTEM MCF value was significantly lower (effect size −6 mm, 95% CI −10 to −3, p < 0.001) in comparison to the lactated Ringer’s solution (RL) group. These results returned to normal within 24 h. We observed no difference in plasma fibrinogen levels (RL 3.08 ± 0.37 g L−1 vs HES 2.65 ± 0.64 g L−1, p = 0.18) or the amount of blood loss between the two groups (RL 470 ± 299 mL vs HES 604 ± 351 mL, p = 0.18). We showed that goal-directed use of HES impairs fibrin polymerization in a dose-dependent manner when compared with RL. Results returned to normal on the first postoperative day without administration of procoagulant drugs and no differences in blood loss were observed.
Highlights
The administration of intravenous fluid therapy is one of the most basic elements of perioperative care
We showed that goal-directed use of hydroxyethyl starch (HES) impairs fibrin polymerization in a dose-dependent manner when compared with Ringer’s solution (RL)
The present study demonstrated that goal-directed fluid management with 6% HES 130/0.4 impaired viscoelastically determined whole-blood coagulation parameters in adult patients undergoing open partial hepatectomy in a dose-dependent manner
Summary
The administration of intravenous fluid therapy is one of the most basic elements of perioperative care. Following two studies published in 2012 [8,9], the European Medicine Agency (EMA) and the US Food and Drug Administration (FDA) issued warnings that hydroxyethyl starch (HES) should no longer be used in critically ill patients due to a possible rise in kidney injury and mortality associated with the administration of HES [10,11]. These recommendations derived from studies performed in critically ill patients, and the EMA explicitly stated that HES could still be used perioperatively, e.g., in the case of acute hemorrhage. Three recently published large outcome trials showed no increase in a composite outcome of major postoperative complications with the perioperative use of HES in comparison with crystalloids [12,13,14]
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