Human Albumin Group Research Articles

Long-term albumin improves the outcomes of patients with decompensated cirrhosis and diabetes mellitus: Post hoc analysis of the ANSWER trial.

Type-2 diabetes mellitus is a frequent comorbidity of cirrhosis independently associated with cirrhosis-related complications and mortality. This post hoc analysis of the ANSWER trial database assessed the effects of long-term human albumin (HA) administration on top of the standard medical treatment (SMT) on the clinical outcomes of a subgroup of 85 outpatients with liver cirrhosis, uncomplicated ascites and insulin-treated diabetes mellitus type 2 (ITDM). Compared to patients in the SMT arm, the SMT + HA group showed a better overall survival (86% vs. 57%, p = .016) and lower incidence rates of paracenteses, overt hepatic encephalopathy, bacterial infections, renal dysfunction and electrolyte disorders. Hospital admissions did not differ between the two arms, but the number of days spent in hospital was lower in the SMT + HA group. In conclusion, in a subgroup of ITDM outpatients with decompensated cirrhosis and ascites, long-term HA administration was associated with better survival and a lower incidence of cirrhosis-related complications.

Perbandingan Efektivitas Terapi Ekstrak Ikan Gabus Dengan Putih Telur Dan Human Albumin 20% Terhadap Peningkatan Kadar Albumin Pasien Hipoalbuminemia Di RSUD dr. Zainoel Abidin

Hypoalbuminemia is a condition where blood albumin levels are less than 3.5 g/dL. In this condition, there will be disruption to the physiological processes in the body. There is a relationship between low albumin levels with an increased risk of infectious complications, a high mortality rate in hospitalized patients, both non-surgical and surgical patients. To restore the important function of albumin, intervention is needed to increase albumin levels in the blood. Human albumin infusion is the most common. However, because of the high price, many other alternatives have been investigated to increase plasma albumin levels. This study aims to determine the effectiveness of snakehead fish extract therapy, compared with egg white and 20% human albumin in increasing albumin levels in hypoalbuminemic patients so that it can save costs and can improve the quality of life of hypoalbuminemia. This research is a quantitative research with Randomized Control Trial design. Samples were collected from August to October 2021 in the surgical inpatient ward of RSUD dr Zainoel Abidin. Data were collected from 36 samples, then divided into 3 treatment groups, namely the egg white group, the snakehead fish extract group and the Human Albumin group. The study used a randomized, blinded clinical trial. The data taken is albumin levels. The data were tested for normality with the Kolmogrov-Sminrnov test, then continued with the ANOVA test. The results obtained 36 samples that meet the inclusion criteria. The average level of increase in the egg white group was -0.0792 (Sig. 0.51), the snakehead fish extract group was 0.1625 (sig. 0.429) and the Human Albumin group was 0.237 (sig. 0.431). From the results of these studies giving snakehead fish extract can be an alternative therapy to treat hypoalbuminemia conditions.Keywords: Hypoalbuminemia, Albumin, Egg white, Snakehead Fish Extract, Human Albumin

Goal-directed therapy with bolus albumin 5% is not superior to bolus ringer acetate in maintaining systemic and mesenteric oxygen delivery in major upper abdominal surgery: A randomised controlled trial.

Goal-directed therapy (GDT) is increasingly used in abdominal surgery. Whether crystalloids can exert the same effect as colloid, and how this may affect perfusion, is still unclear. The effect of GDT on the systemic oxygen delivery index (sDO2I) and the mesenteric oxygen delivery index (mDO2I) can be quantified by measuring cardiac index and flow in the superior mesenteric artery, respectively. The aim of this study was to test the hypothesis that intra-operative GDT with bolus human albumin 5% is superior to GDT with bolus ringer acetate in maintaining sDO2I and mDO2I in elective major upper gastrointestinal cancer surgery. Randomised controlled double blinded trial. Odense University Hospital, Denmark, from May 2014 to June 2015. A total of 89 adults scheduled for elective major upper gastrointestinal cancer surgery were randomised and data from 60 were analysed. contraindications for using the LiDCOplus system, known allergy to albumin, pre-operative renal failure, pancreatic cancer and pre-operative down staging using chemotherapy and/or radiation therapy, pregnancy. Patients were randomised to intra-operative GDT with either bolus human albumin or ringer acetate 250 ml, guided by pulse pressure variation and stroke volume. Changes in sDO2I and mDO2I. Secondary outcomes were changes in other haemodynamic variables, fluid balance, blood transfusions, fluid-related complications and length of stay (LOS) in ICU and hospital. Median [IQR] sDO2I was 522 [420 to 665] ml min m in the ringer acetate group and 490 [363 to 676] ml min m in the human albumin group, P = 0.36. Median [IQR] mDO2I was 12.1 [5.8 to 28.7] ml min m in the ringer acetate group and 17.0 [7.6 to 27.5] ml min m in the human albumin group, P = 0.17. Other haemodynamic comparisons did not differ significantly. More trial fluid was administered in the ringer acetate group. We found no significant difference in transfusions, complications or LOS. Bolus human albumin 5% was not superior to bolus ringer acetate in maintaining systemic or mesenteric oxygen delivery in elective major upper gastrointestinal cancer surgery, despite the administration of larger volumes of trial fluid in the ringer acetate group. No significant difference was seen in fluid-related complications or LOS. https://eudract.ema.europa.eu/ Identifier: 2013-002217-36.

Artificial colloids versus human albumin for the treatment of ovarian hyperstimulation syndrome: A retrospective cohort study.

BackgroundThe optimal colloid solution for the treatment of ovarian hyperstimulation syndrome (OHSS) remains to be established.ObjectiveWe aimed to compare artificial colloids (AC) with human albumin (HA) for the treatment of OHSS.Materials and MethodsIn this retrospective cohort study, data for OHSS participants were collected from a national inpatient database in Japan. The participants received intravenous fluid management with AC (n = 156) or HA (n = 127). We compared the two groups in terms of the length of stay, development of post-treatment complications, and termination surgery.ResultsIn multivariable linear regression analyses for log-transformed length of stay with reference to the OHSS participants receiving AC, the regression coefficient (95% confidence interval) in participants receiving HA was 0.03 (-0.04-0.09, p = 0.42). Thromboembolism occurred in two participants in the HA group and three participants in the AC group. Two participants in the HA group suffered renal failure during hospitalization. No participants underwent termination surgery in the two groups.ConclusionThe present results showed comparable efficacy between AC and HA for the treatment of OHSS. There were no significant differences in post-treatment complications between the two groups.

Effects of resuscitation with human albumin 5%, hydroxyethyl starch 130/0.4 6%, or crystalloid on kidney damage in an ovine model of septic shock

BackgroundColloid solutions have been associated with kidney dysfunction in septic animals and humans. The present study investigated the influence of resuscitation with human albumin (HA) 5%, hydroxyethyl starch (HES) 130/0.4 6%, and balanced crystalloids on ultrastructural kidney damage, kidney function, and survival in a model of ovine septic shock. MethodsAfter induction of peritoneal septic shock, animals were randomised to one of the following groups: (1) HA 5%, (2) HES 130/0.4 6%, (3) balanced crystalloid, and (4) control (each n=10). Causal therapy included re-laparotomy, peritoneal lavage, and antimicrobial therapy. Sequential kidney biopsies were obtained for the assessment of the electron microscopic tubular injury (EMTI) score. ResultsSerum creatinine and urea were highest in the control group, and there were no differences between the intervention groups. Cumulative diuresis was significantly higher in the HA group [1.0 ml kg−1 h−1 (0.6; 1.2)] compared with control [0.7 ml kg−1 h−1 (0.6; 0.9), P<0.05]. Creatinine clearance was highest in the HA and crystalloid groups. Ultrastructural kidney damage was highest in the control group [EMTI score 7.8 (6.7; 9.0)] without differences between intervention groups. Survival was 100% in the colloid groups vs 90% (crystalloid) and 60% (control, all P<0.05). ConclusionIn an ovine model of septic shock, kidney function and cumulative diuresis were preserved in the 5% albumin and crystalloid resuscitation groups, whereas HES 130/0.4 6% resulted in diminished creatinine clearance. Differences in kidney function between resuscitation fluids could not be explained by differences in ultrastructural kidney damage. Clinical trial registration84-02.04.2011.A300.

Long-term albumin administration in decompensated cirrhosis (ANSWER): an open-label randomised trial

Evidence is scarce on the efficacy of long-term human albumin (HA) administration in patients with decompensated cirrhosis. The human Albumin for the treatmeNt of aScites in patients With hEpatic ciRrhosis (ANSWER) study was designed to clarify this issue. We did an investigator-initiated multicentre randomised, parallel, open-label, pragmatic trial in 33 academic and non-academic Italian hospitals. We randomly assigned patients with cirrhosis and uncomplicated ascites who were treated with anti-aldosteronic drugs (≥200 mg/day) and furosemide (≥25 mg/day) to receive either standard medical treatment (SMT) or SMT plus HA (40 g twice weekly for 2 weeks, and then 40 g weekly) for up to 18 months. The primary endpoint was 18-month mortality, evaluated as difference of events and analysis of survival time in patients included in the modified intention-to-treat and per-protocol populations. This study is registered with EudraCT, number 2008-000625-19, and ClinicalTrials.gov, number NCT01288794. From April 2, 2011, to May 27, 2015, 440 patients were randomly assigned and 431 were included in the modified intention-to-treat analysis. 38 of 218 patients died in the SMT plus HA group and 46 of 213 in the SMT group. Overall 18-month survival was significantly higher in the SMT plus HA than in the SMT group (Kaplan-Meier estimates 77% vs 66%; p=0·028), resulting in a 38% reduction in the mortality hazard ratio (0·62 [95% CI 0·40-0·95]). 46 (22%) patients in the SMT group and 49 (22%) in the SMT plus HA group had grade 3-4 non-liver related adverse events. In this trial, long-term HA administration prolongs overall survival and might act as a disease modifying treatment in patients with decompensated cirrhosis. Italian Medicine Agency.

Effects of colloid pre-loading on thromboelastography during elective intracranial tumor surgery in pediatric patients: hydroxyethyl starch 130/0.4 versus 5% human albumin

BackgroundVolume replacement therapy with colloid is still worth studying in major pediatric surgery with potential risk of bleeding. This study assessed the effects of 6% hydroxyethyl starch (HES) 130/0.4 and 5% Human Albumin (HA) on coagulation tested by thromboelastography (TEG) during elective intracranial tumor surgery in pediatric patients.MethodsIn this randomized controlled trial, 60 patients undergoing intracranial tumor resection under general anesthesia were assigned to HES and HA groups (n = 30), and administered preloads of 20 mL · kg−1 HES 130/0.4 and 5% HA, respectively, prior to dura opening. Primary outcomes were perioperative thromboelastography findings, and hemodynamic and hematological parameters. Blood transfusion, perioperative fluid balance, intracranial pressure, mortality, intensive care unit stay, and hospital stay were also assessed.ResultsTEG parameters did not differ after preloading compared to baseline values in either group, except for a decrease in maximum amplitude immediately after infusion (HES group, 57.6 ± 6.0 mm vs. 50.9 ± 9.2 mm; HA group, 60.1 ± 7.9 mm vs. 56.6 ± 7.1 mm; p < 0.01), which was restored to preoperative levels 1 h after fluid infusion. Total perioperative fluid balance, blood loss or transfusion, intracranial pressure, and hematological and hemodynamic variables were similar between both groups (p > 0.05). Mortality, length of hospital stay, and clinical complications were similar between both groups.ConclusionThese findings suggest that HES and HA might have no significant differences regarding coagulation as assessed by TEG during pediatric intracranial tumor surgery with 20 ml/kg volume pre-loading, which can maintain stable hemodynamics and may represent a new avenue for volume therapy during brain tumor resection in pediatrics.Trial registrationChiCTR-IPR-16009333, retrospectively registered October 8, 2016

Impact of Albumin on Coagulation Competence and Hemorrhage During Major Surgery: A Randomized Controlled Trial.

For patients exposed to a massive blood loss during surgery, maintained coagulation competence is important. It is less obvious whether coagulation competence influences bleeding during elective surgery where patients are exposed to infusion of a crystalloid or a colloid.This randomized controlled trial evaluates whether administration of 5% human albumin (HA) or lactated Ringer solution (LR) affects coagulation competence and in turn blood loss during cystectomy due to bladder cancer.Forty patients undergoing radical cystectomy were included to receive either 5% HA (n = 20) or LR (n = 20). Nineteen patients were analyzed in the HA group and 20 patients in the lactated Ringer group.Blinded determination of the blood loss was similar in the 2 groups of patients: 1658 (800–3300) mL with the use of HA and 1472 (700–4330) mL in the lactated Ringer group (P = 0.45). Yet, by thrombelastography (TEG) evaluated coagulation competence, albumin affected clot growth (TEG-angle 69 ± 5 vs 74° ± 3°, P < 0.01) and strength (TEG-MA: 59 ± 6 vs 67 ± 6 mm, P < 0.001) more than LR. Furthermore, by multivariate linear regression analyses reduced TEG-MA was independently associated with the blood loss (P = 0.042) while administration of albumin was related to the changes in TEG-MA (P = 0.029), aPPT (P < 0.022), and INR (P < 0.033).This randomized controlled trial demonstrates that administration of HA does not affect the blood loss as compared to infusion of LR. Also the use of HA did not affect the need for blood transfusion, the incidence of postoperative complications, or the hospital in-stay. Yet, albumin decreases coagulation competence during major surgery and the blood loss is related to TEG-MA rather than to plasma coagulation variables.

Therapeutic Plasma Exchange in Patients with Neurologic Disorders: Review of 63 Cases.

Therapeutic plasma exchange (TPE) is a procedure that reduces circulating autoantibodies of the patients. TPE is commonly used in neurological disorders where autoimmunity plays a major role. We report our experience with regard to the indications, adverse events and outcomes of plasma exchange in neurological disorders. Sixty-three patients were included to this retrospective study. Median age was 48years (range 1-85), there was a predominance of males. Neurological indications included Guillain-Barrè syndrome (n=22), myasthenia gravis (n=21), chronic inflammatory demyelinating polyneuropathy (n=7), polymyositis (n=3), multifocal motor neuropathy (n=2), acute disseminated encephalomyelitis (n=2), neuromyelitis optica (n=2), multiple sclerosis (n=2), limbic encephalitis (n=1) and transverse myelitis (n=1). TPE was frontline therapy in 57% of the patients (n=36). Total number of TPE sessions was 517; median number of sessions per patient was 8 (range 1-66). TPE was done through a central venous access in 97% and through a peripheral venous access in 3% of the patients. Human albumin was used as replacement fluid in 49%, hydroxyethyl starch (HES) in 49% and fresh frozen plasma in 2% of the cases. Adverse reactions were recorded in 60% of the patients. Total ratio of complications in 517 TPE procedures was 10.8% and these were mild and manageable such as allergic reactions and hypotension. Overall response rate was 81%. Interestingly, complication and response rates were similar in both HES and human albumin groups. We conclude that TPE is an effective treatment in neurologic diseases in which autoimmunity plays an important role in the pathogenesis and HES can be used instead of albumin as replacement fluid in these disorders, since it is cost-effective, has similar efficacy and complication rates.

Comparison of the Effects of Albumin 5%, Hydroxyethyl Starch 130/0.4 6%, and Ringer’s Lactate on Blood Loss and Coagulation After Cardiac Surgery

Abstract Background Infusion of 5% human albumin (HA) and 6% hydroxyethyl starch 130/0.4 (HES) during cardiac surgery expand circulating volume to a greater extent than crystalloids and would be suitable for a restrictive fluid therapy regimen. However, HA and HES may affect blood coagulation and could contribute to increased transfusion requirements. Methods We randomly assigned 240 patients undergoing elective cardiac surgery to receive up to 50 ml kg−1 day−1 of either HA, HES, or Ringer's lactate (RL) as the main infusion fluid perioperatively. Study solutions were supplied in identical bottles dressed in opaque covers. The primary outcome was chest tube drainage over 24 h. Blood transfusions, thromboelastometry variables, perioperative fluid balance, renal function, mortality, intensive care unit, and hospital stay were also assessed. Results The median cumulative blood loss was not different between the groups (HA: 835, HES: 700, and RL: 670 ml). However, 35% of RL patients required blood products, compared with 62% (HA) and 64% (HES group; P=0.0003). Significantly, more study solution had to be administered in the RL group compared with the colloid groups. Total perioperative fluid balance was least positive in the HA group [6.2 (2.5) litre] compared with the HES [7.4 (3.0) litre] and RL [8.3 (2.8) litre] groups (P Conclusions Despite equal blood loss from chest drains, both colloids interfered with blood coagulation and produced greater haemodilution, which was associated with more transfusion of blood products compared with crystalloid use only.

Comparison of low molecular weight hydroxyethyl starch and human albumin as priming solutions in children undergoing cardiac surgery

Human albumin is the conventional cardiopulmonary bypass circuit primer. However, it has high manufacturing costs. Crystalloid and colloid solutions have been developed as alternatives, including a new generation of non-ionic hydroxyethyl starch (HES). The efficacy of hydroxyethyl starch with a 130 molecular weight and substitution degree of 0.4 (hydroxyethyl starch 130/0.4) was compared with human albumin for use in cardiopulmonary bypass surgery in American Society of Anesthesiologists' grade I-II pediatric congenital heart disease patients. Efficacy was evaluated by comparing perioperative hemodynamic parameters, including plasma colloid osmotic pressure, renal function, blood loss, allogeneic blood volumes and plasma volume substitution. The hydroxyethyl starch group exhibited significantly higher preoperative colloid osmotic pressure (p<0.01) and significantly lower operative renal function and postoperative allogeneic blood volumes than the human albumin group. No significant differences were observed in serum creatinine, glucose, hematocrit or lactic acid levels (p>0.05). Our results indicate that hydroxyethyl starch may be a viable alternative to human albumin in pediatric patients undergoing relatively simple cardiopulmonary bypass surgeries.

Comparison of the effects of albumin 5%, hydroxyethyl starch 130/0.4 6%, and Ringer’s lactate on blood loss and coagulation after cardiac surgery

BackgroundInfusion of 5% human albumin (HA) and 6% hydroxyethyl starch 130/0.4 (HES) during cardiac surgery expand circulating volume to a greater extent than crystalloids and would be suitable for a restrictive fluid therapy regimen. However, HA and HES may affect blood coagulation and could contribute to increased transfusion requirements. MethodsWe randomly assigned 240 patients undergoing elective cardiac surgery to receive up to 50 ml kg−1 day−1 of either HA, HES, or Ringer’s lactate (RL) as the main infusion fluid perioperatively. Study solutions were supplied in identical bottles dressed in opaque covers. The primary outcome was chest tube drainage over 24 h. Blood transfusions, thromboelastometry variables, perioperative fluid balance, renal function, mortality, intensive care unit, and hospital stay were also assessed. ResultsThe median cumulative blood loss was not different between the groups (HA: 835, HES: 700, and RL: 670 ml). However, 35% of RL patients required blood products, compared with 62% (HA) and 64% (HES group; P=0.0003). Significantly, more study solution had to be administered in the RL group compared with the colloid groups. Total perioperative fluid balance was least positive in the HA group [6.2 (2.5) litre] compared with the HES [7.4 (3.0) litre] and RL [8.3 (2.8) litre] groups (P<0.0001). Both colloids affected clot formation and clot strength and caused slight increases in serum creatinine. ConclusionsDespite equal blood loss from chest drains, both colloids interfered with blood coagulation and produced greater haemodilution, which was associated with more transfusion of blood products compared with crystalloid use only.

Retraction Note: Volume therapy in the critically ill: is there a difference?

Objective: There are still several concerns about the extensive and prolonged use of hydroxyethylstarch solution (HES) in critically ill patients. The effects of volume replacement with HES over 5 days on hemodynamics, laboratory data, and organ function were compared with volume therapy using human albumin (HA). Design: Prospective, randomized study. Setting: Clinical investigations on a surgical intensive care unit (ICU) of a university hospital. Patients: 150 traumatized patients (injury severity score > 15) and 150 postoperative patients with sepsis were analyzed. Interventions: Either 10 % low-molecular weight HES (HES-trauma, n = 75; HES-sepsis, n = 75) or 20 % HA (HA-trauma, n = 75; HA-sepsis, n = 75) was given for 5 days to maintain the pulmonary capillary wedge pressure (PCWP) between 12 and 15 torr. The entire management of therapy of the patients was performed by physicians who were not involved in the study and blinded to the infusion regimen. Measurements and results: In addition to extensive cardiorespiratory monitoring, several routine laboratory parameters for assessing pulmonary, renal, hepatic, and coagulation function were analyzed from arterial blood samples on the day of admission to the ICU and on the day of sepsis diagnosis, respectively (“baseline” value) and daily over the following 5 days. Mortality during and after the study did not differ significantly between the infusion groups. There were also no differences between the incidence of pulmonary, renal, or hepatic failure in the two subgroups. Mean arterial pressure, heart rate, and PCWP were similar in both subgroups, whereas cardiac index, oxygen delivery index, oxygen consumption index, and the ratio between the partial pressure of oxygen in arterial blood and fractional inspired oxygen were higher in the HES- than in the HA-treated groups. Standard coagulation parameters did not differ, albumin concentration increased significantly in both HA groups, and lactate concentrations decreased only in the HES-sepsis patients (from 2.8 ± 0.5 to 1.5 ± 0.4 mg/dl). Volume replacement using albumin was significantly (p < 0.001) more costly than therapy with HES. Conclusions: Volume therapy with 10 % HES for 5 days in the ICU patient showed no disadvantages compared with an infusion regimen using 20 % albumin. Volume replacement using HES may even be associated with improved hemodynamics. HES appears to be a valuable and significantly cheaper alternative to albumin – even for prolonged volume therapy in the critically ill patient.

Comparison of cabergoline and intravenous albumin in the prevention of ovarian hyperstimulation syndrome: a randomized clinical trial

To compare the efficacy of cabergoline (Cb2) and intravenous human albumin (HA) in the prevention of ovarian hyperstimulation syndrome. In this randomized controlled trial study, 138 women who were at high risk for developing OHSS were randomly allocated into two groups. In Group one, 20 gr of HA 20% was infused over 1 h. Group two received 0.5 mg per day of Cb2 orally for 7 days, starting on oocyte pickup day. All patients were visited seven and 14 days after oocyte retrieval to determine early clinical or ultrasound evidence of OHSS. Moderate OHSS was observed in 33 versus 14 cases in the HA and Cb2 groups, respectively, which was significantly different. The number of severe OHSS cases in the HA group was significantly higher than in the Cb2 group (P < 0.001). Prophylactic oral low dose cabergoline was more effective and less costly than intravenous human albumin in the prevention of OHSS in high-risk patients.

Protective effects of hydroxyethyl starch on myocardial ischemia/reperfusion injury in rabbits

Objective To observe the effects of hydroethyl starch (HES 130/0.4) on serum interleukin-8, endothelin-l(ET-1) and myocardial myeloperoxidase activity (MP0) in rabbits subjected to ischemia-reperfusion, and to explore its possible mechanism. Method Thirty-six rabbits were randomly divided into three groups: lac-tated Ringer's solution group (group A, n= 12), 5% human albumin group (group B, n= 12) and 6% hy-droethyl starch group (group C, n= 12) Hie myodardial ischemia/reperfusion (MI/R) model was established by clamping left anterior descending coronary artery for 30 minutes followed by reperfusion for 180 minutes. Fifteen minutes prior to reperfusion, animals of these 3 given groups were ifused vis right internal jugular vein with 6 ml/kg lactated Ringer'solution, 5% human albumin and hydroethyl starch, respectively. Blood samples were obtained before occlusion (I_0),30 minutes after occlusion (I_1), 60 minutes (R_1) and 180 (R_2) minutes after reperfusion to determine the activities of serum lactate dehydrogenase (LDH), serum creatine phosphokinase (CPK), serum interleukin-8(IL-8) and endotheun-1 (ET-1).The size of myocardial infarction (MI),myocardial water content and myoloperoxidase activity (MPO) were examined as well.Statistical analyses were performed by using SPSS 12.0 software. Multiple comparisons were analyzed by using one-way analysis of variance (SNK- qtest). P ＜ 0.05 was considered statistically significant. Results The serum IDH, CPK,IL-8 and ET-1 weregradually increased after reperfusion, however, 180 min after reperfusion all serum biomarkers in 6% hydroethylstarch group (group C) were significantly lower than those in Iactated Ringer's solution group (group A) [(181 ±17) U/lvs. (334±39) U/L; (1927±205) U/L vs. (2987±326) U/L; (5.03±1.16) ng/L vs. (6.96±1.21) ng/L; (380±78.4) ng/L vs. (667.2±82.1) ng/L. all P ＜0.05], and than those in 5% human albu-min group (group B) [(181 ±17) U/L vs. (320±38) U/L; (1727 ±205) U/L vs. (2218 ±290) U/L; (5.03 ±1.16) ng/L vs. (5.90±1.03) ng/L; (380.9±78.4) ng/L vs. (615.6±80.2) ng/L, all P ＜0.05]. Theactivity of MPO of ischemic area in group C (0.20 ± 0.09 ng/L) was significantly lower than that in group A(0.48±0.15 ng/L) and in group B (0.37 ±0.12 ng/L) (P ＜ 0.05). Myocardial water content and infarct sizeof heart found in group C were significantly smaller than those in both group A and group B (P ＜ 0.05). Conclu-sions The 6% hydroethyl starch exhibits its protective effects on myocardial ischemia-reperfusion injury by pre-venting the production and release of serum IL-8 and ET-1, decreasing neutrophil infiltration capillary permeabilityand improving microvascular circulation. Key words: Hydroxyethyl starch; Reperfusion injury; Interleukin-8; Endothelin-1; Myeloperoxidase

Comparison of Citrate Anticoagulation During Plasma Exchange With Different Replacement Solutions

The aim of our retrospective study was to compare the application of regional citrate anticoagulation and citrate-related side-effects in plasma exchange (PE) with different replacement solutions. We included 35 patients treated with PE with regional citrate anticoagulation and divided them into three groups according to the replacement solution used: human albumin (HA) group (40 PE treatments), fresh frozen plasma (FFP) group (86 PE treatments), or a combination of the two (63 PE treatments). The citrate anticoagulation parameters, ionized calcium and metabolic consequences of citrate were compared. The blood flow and citrate infusion rates were similar in all groups. To maintain comparable values of ionized calcium during PE, significantly more calcium was replaced in the combination group (7.6 +/- 1.3 vs. 6.2 +/- 2.7 mL/h, P < 0.001) and even more in the FFP group (10.8 +/- 1.7 vs. 6.2 +/- 2.7 mL/h, P < 0.001) as compared to the HA group. The pH increased significantly and comparably in all groups, but the increase in bicarbonate was significantly higher in the FFP group (4.4 +/- 3.0 vs. 2.6 +/- 2.1 mmol/L, P = 0.01). A short, heparin-free hemodialysis session was performed after the PE treatment, because of significant metabolic alkalosis (mainly with pH > or = 7.5), significantly more often in the FFP group (14/86 PE, P < 0.01) as compared to the HA group (0/40), and only rarely in the combination group (2/63). To conclude, when FFP is used as a replacement solution during PE with citrate anticoagulation, significantly more calcium needs to be replaced and the increase in bicarbonate is greater during PE. The additional citrate contained in FFP, combined with frequent PE treatments, often causes significant metabolic alkalosis, which can be efficiently corrected with a short heparin-free hemodialysis.

Haemodynamics and Acid-Base Equilibrium after Cardiac Surgery: Comparison of Rapidly Degradable Hydroxythyl Starch Solutions and Albumin

Stable haemodynamics is often achieved by administration of colloids after cardiac surgery. We conducted a prospective, randomized, open-label study comparing haemodynamics and acid-base equilibrium after infusion of two rapidly degradable hydroxyethyl starch (HES) solutions or human albumin (HA) to cardiac surgical patients. 45 patients received a predetermined fixed dose of 15 ml kg(-1) of either 6% HES (mW 130 kDa, n = 15), 6% HES (MW 200 kDa, n = 15) or 4% HA (MW 69 kDa, n = 15) after on-pump cardiac surgery. Left ventricular filling pressures assessed using pulmonary artery catheter responded similarly in all groups. mean (SD) cardiac index was higher in HES130 [3.5 l min(-1) m(-2) (0.7) ] and HES200 [3.5 l min(-1) m(-2) (0.5)] than in HA [2.8 l min(-1) m(-2) (0.6)] group after completion of infusion (P = 0.002) but no differences were detected at 2 and 18 hours. Oxygen delivery increased in both HES groups but not in HA group. After cessation of infusion base excess was the most negative in Ha group. At 2 hours mean (SD) base excess was higher in HES130 [0 (1.32)] than in HES200 [-1.32 (2.27) ] and HA [-2.3 (1.3)] group (P = 0.002, between the groups). We conclude that the effect of albumin on cardiac performance is inferior than that of HES130 or HES200 in early postoperative phase after cardiac surgery. HES130 induces no alterations in acid-base equilibrium whereas a negative base excess was observed after HA infusion.

HES 130/0.4 (Voluven®) or human albumin in children younger than 2 yr undergoing non-cardiac surgery. A prospective, randomized, open label, multicentre trial

For perioperative volume therapy in infants and young children, human albumin has frequently been the colloid of choice. Recently, HES 130/0.4 (6% hydroxyethyl starch, Voluven; Fresenius Kabi, Bad Homburg, Germany) was developed, which demonstrated improved pharmacokinetics and a favourable safety profile in adults compared with hydroxyethyl starch products with a less rapid metabolization. Our prospective, controlled, randomized, open, multicentre pilot study was designed to obtain data on the effects of HES 130/0.4 compared with human albumin 5% with regard to haemodynamics in children <2 yr scheduled for elective non-cardiac surgery. A total of 81 patients were treated. Comparable amounts of both study solutions (16.0 mL kg(-1) hydroxyethyl starch 130/0.4 vs. 16.9 mL kg(-1) human albumin 5%) as well as add-on crystalloids were used until 4-6 h postoperatively. No differences were detected between the two treatment groups regarding perioperative stabilization of haemodynamics, coagulation parameters, blood gas analyses or other laboratory values. Blood loss was 96 +/-143 mL for hydroxyethyl starch and 145+/- 290 mL for human albumin (P > 0.05). There were no relevant differences in the amount of red blood cells, fresh frozen plasma or platelet concentrates in both treatment groups. Median length of ICU stay was 3.5 days (range 1-57 days, mean +/- SD 7.6 +/- 11.5 days) in the hydroxyethyl starch group and 6.0 days (range 1-71 days; mean +/- SD 9.1 +/- 14.2 days) in the human albumin group. There was no difference for hospital stay (median: 12 days for both groups). Both HES 130/0.4 and human albumin 5% were effective for haemodynamic stabilization in non-cardiac surgery of young infants with no adverse impact on coagulation or other safety parameters in our study population.

A Comparison of the Haemodynamic Effects of 4% Succinylated Gelatin, 6% Hydroxyethyl Starch (200/0.5) and 4% Human Albumin after Cardiac Surgery

The goal for volume replacement therapy is to maintain stable haemodynamics after cardiac surgery. We hypothesized that a short term infusion of hydroxyethyl starch results in better haemodynamic response than an infusion of lower molecular weight gelatin. 45 patients received a predetermined fixed dose of 15 ml kg(-1) of either 4% succinylated gelatin (GEL) or 6% hydroxyethyl starch (HES) or 4% human albumin (HA) after cardiac surgery. Pulmonary capillary wedge pressure was more increased in GEL and HES groups [mean (SD) 153% (54) and 168% (57) of pre-infusion value] than in HA group [122% (23)] (P = 0.031) after completion of infusion, but no differences in cardiac index (CI) and stroke volume index (SVI) were observed. At 2 and 18 hours after end of study infusions SVI was more increased in HES [143% (38) and 148% (41) of pre-infusion values] and HA [143% (35) and 163% (42) of pre-infusion values] groups than in GEL [116% (23) and 125% (30)] group (P = 0.047 at 2 hours and P = 0.033 at 18 hours). In early postoperative phase after cardiac surgery, HES and HA infusions improve haemodynamics more and longer period than GEL infusion.

P-22: Intravenous hydroxyethyl starch versus human albumin for prevention of the ovarian hyperstimulation syndrome

To compare the efficacy of hydroxyethyl starch(HES) and human albumin as colloid solutions for prevention of the ovarian hyperstimulation syndrome (OHSS). A prospective, randomized and placebo-controlled study was conducted to assess the effectiveness of intravenous of 6% hydroxyethyle starch solution, human albumin or 10% glucose at the time of oocyte retrieval in preventing severe OHSS in high risk patients in an in-vitro fertilization programme. All patients had more than 30 follicles by ultrasound on the day of human chorionic gonadotrophin (hCG) administration. There were 47 patients in human albumin group, 46 patients in HES group, and 49 patients in control group. The concentration of serum oestradiol and the ovarian size were measured on the day of hCG, the day of oocyte collection and the day of embryo transfer. And the number of transferred patients, the number of embryos transferred, pregnancies and occurrence of severe OHSS were observed in the study. There were no significant differences of the number of transferred patients, number of embryo transferred, pregnancies and occurrence of severe OHSS in three groups (P>0.05). Although there were no significant differences of the ovarian enlargement in three groups on the day of embryo transfer and on the day of hCG administration (P>0.05), it was lower in HES group than that in albumin group (P=0.082). The increase of serum E2 concentration was lower in HES group than that in the other two groups on the day of embryo transfer and on the day of oocyte collection, but no significant differences were founded (p values were 0.118 and 0.075 compared with the albumin group and the control group, respectively). Administration of HES did not prevent the development of severe OHSS in high-risk patients, but it may help in lowering the ovarian enlargement and the serum E2 concentration increase. Larger sample is needed to evaluate the potential of this novel approach.