Hydroxyethyl Starch Research Articles

Validation of the relationship between coagulopathy and localization of hydroxyethyl starch on the vascular endothelium in a rat hemodilution model

Various anticoagulant properties have been associated with hydroxyethyl starch (HES). However, the mechanism remains unclear and it has not been fully considered whether these properties are beyond the dilutional effect itself. The aim of this study was to reproduce the coagulopathy induced by HES and to test the hypothesis that the coagulopathy is caused by endothelial or glycocalyx damage due to localization of HES on the endothelium, which is caused by the high shear viscosity of dilutional blood. Using a rat model, we compared blood coagulability measured by Sonoclot, levels of endothelial and glycocalyx damage markers and coagulation factors, and blood shear viscosity when hemodilution was performed with physiological saline (PS), 6% HES 130/0.4 in PS, and 10% HES 200/0.5 in PS. We also evaluated the localization rates of fluorescently labeled HES on endothelium in the isolated aorta. HES decreased the fibrin gel formation rate more than did PS. HES was shown to cover the endothelium, possibly due to its high shear viscosity, and this mechanism potentially acted to protect, rather than damage, the endothelium and glycocalyx. However, this covering effect may be the cause of coagulopathy due to inhibition of von Willebrand factor secretion from the endothelium.

Effects of positive end-expiratory pressure on the predictability of fluid responsiveness in acute respiratory distress syndrome patients

The prediction accuracy of pulse pressure variation (PPV) for fluid responsiveness was suggested to be unreliable in low tidal volume (VT) ventilation. However, high PEEP can cause ARDS patients relatively hypovolemic and more fluid responsive. We hypothesized that high PEEP 15 cmH2O can offset the disadvantage of low VT and improve the predictive performance of PPV. We prospectively enrolled 27 hypovolemic ARDS patients ventilated with low VT 6 ml/kg and three levels of PEEP (5, 10, 15 cmH2O) randomly. Each stage lasted for at least 5 min to allow for equilibration of hemodynamics and pulmonary mechanics. Then, fluid expansion was given with 500 ml hydroxyethyl starch (Voluven 130/70). The hemodynamics and PPV were automatically measured with a PiCCO2 monitor. The PPV values were significantly higher during PEEP15 than those during PEEP5 and PEEP10. PPV during PEEP15 precisely predicts fluid responsiveness with a cutoff value 8.8% and AUC (area under the ROC curve) of ROC (receiver operating characteristic curve) 0.847, higher than the AUC during PEEP5 (0.81) and PEEP10 (0.668). Normalizing PPV with driving pressure (PPV/Driving-P) increased the AUC of PPV to 0.875 during PEEP15. In conclusions, high PEEP 15 cmH2O can counteract the drawback of low VT and preserve the predicting accuracy of PPV in ARDS patients.

In Response to Colloids Use in Asian ICU Patients: Do not Mix Oranges with Apples. Consider the Proven Concerns on Hydroxyethyl Starch Use in ICU patients.

How to cite this article: Ertmer C. In Response to Colloids Use in Asian ICU Patients: Do not Mix Oranges with Apples. Consider the Proven Concerns on Hydroxyethyl Starch Use in ICU Patients. Indian J Crit Care Med 2021;25(5):597.

Colloids Use in Asian ICU Patients: Do not Mix Oranges with Apples. Consider the Proven Concerns on Hydroxyethyl Starch Use in ICU Patients.

How to cite this article: Giordano G, Purgatori A, Bilotta F. Colloids Use in Asian ICU Patients: Do not Mix Oranges with Apples. Consider the Proven Concerns on Hydroxyethyl Starch Use in ICU Patients. Indian J Crit Care Med 2021;25(5):595–596.

Intravenous Fluid Administration and the Coagulation System.

Intravenous fluid administration in veterinary patients can alter coagulation function by several mechanisms. Both crystalloid and colloid fluids cause hemodilution, reducing platelet count and plasma coagulation protein concentrations. Hemodilution is associated with a hypercoagulable effect at low dilutions and a hypocoagulable effect at higher dilutions. Composition of crystalloid fluids likely has a minor effect, primarily dependent on fluid ion composition. Hypertonic crystalloids may also cause hypocoagulability. Colloids, both synthetic and natural, can cause hypocoagulability by several mechanisms beyond the effects of hemodilution. These include impaired platelet function, decreased plasma coagulation factor activity, impaired fibrin formation and crosslinking, and accelerated fibrinolysis. The vast majority of the veterinary literature investigates the hypocoagulable effects of hydroxyethyl starch–containing fluids using in vitro, experimental, and clinical studies. However, results are inconsistent, likely due to the varying doses and physicochemical properties of the specific fluid products across studies. In addition, some evidence exists for hypocoagulable effects of gelatin and albumin solutions. There is also evidence that these colloids increase the risk of clinical bleeding in people. Limitations of the veterinary evidence for the hypocoagulable effects of colloid fluids include a predominance of in vitro studies and in vivo studies using healthy subjects, which exclude the interaction of the effects of illness. Therefore, clinical relevance of these effects, especially for low-molecular-weight hydroxyethyl starch, is unknown. Firm recommendations about the most appropriate fluid to use in clinical scenarios cannot be made, although it is prudent to limit the dose of synthetic colloid in at-risk patients. Clinicians should closely monitor relevant coagulation assays and for evidence of hemorrhage in at-risk patients receiving any type of fluid therapy, especially in large volumes.

Cryopreservation of human cerebral microvascular endothelial cells and astrocytes in suspension and monolayers.

The blood–brain barrier (BBB) keeps pathogens and toxins out of the brain but also impedes the entry of pharmaceuticals. Human cerebral microvascular endothelial cells (hCMECs) and astrocytes are the main functional cell components of the BBB. Although available commercially as cryopreserved cells in suspension, improvements in their cryopreservation and distribution as cryopreserved monolayers could enhance BBB in vitro studies. Here, we examined the response to slow cooling and storage in liquid nitrogen of immortalized hCMEC/D3 cells and human primary astrocytes in suspension and in monolayers. HCMEC/D3 cells in suspension cryopreserved in 5% dimethyl sulfoxide (DMSO) and 95% fetal bovine serum or in 5% DMSO and 6% hydroxyethyl starch (HES) showed post-thaw membrane integrities above 90%, similar to unfrozen control. Cryopreservation did not affect the time-dependent ability of hCMEC/D3 cells to form tubes on Matrigel. Primary astrocytes in suspension cryopreserved in the presence of 5% DMSO and 6% HES had improved viability over those cryopreserved in 10% DMSO. Monolayers of single cultures or co-cultures of hCMEC/D3 cells and astrocytes on fibronectin-coated Rinzl coverslips retained membrane integrities and metabolic function, after freezing in 5% DMSO, 6% HES, and 2% chondroitin sulfate, that were comparable to those of unfrozen controls even after overnight incubation. Rinzl is better than glass or Thermanox as an underlying solid substrate for cryopreserving hCMEC/D3 monolayers. Cryopreserved hCMEC/D3 monolayers expressed the junction proteins ZO-1 and claudin-5 similar to their unfrozen counterparts. Hence, we describe improved cryopreservation protocols for hCMEC/D3 cells and astrocytes in suspension, and a novel protocol for the cryopreservation of monolayers of hCMEC/D3 cells and astrocytes as single cultures or co-cultures that could expand their distribution for research on disease modeling, drug screening, and targeted therapy pertaining to the BBB.

Dopamine agonists for preventing ovarian hyperstimulation syndrome.

Ovarian hyperstimulation syndrome (OHSS) is a potentially serious complication of ovarian stimulation in assisted reproduction technology (ART). It is characterised by enlarged ovaries and an acute fluid shift from the intravascular space to the third space, resulting in bloating, increased risk of venous thromboembolism, and decreased organ perfusion. Most cases are mild, but forms of moderate or severe OHSS appear in 3% to 8% of in vitro fertilisation (IVF) cycles. Dopamine agonists were introduced as a secondary prevention intervention for OHSS in women at high risk of OHSS undergoing ART treatment. OBJECTIVES: To assess the effectiveness and safety of dopamine agonists in preventing OHSS in women at high risk of developing OHSS when undergoing ART treatment. We searched the following databases from inception to 4 May 2020: Cochrane Gynaecology and Fertility Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, and PsycINFO for randomised controlled trials (RCTs) assessing the effect of dopamine agonists on OHSS rates. We also handsearched reference lists and grey literature. We considered RCTs for inclusion that compared dopamine agonists with placebo/no intervention or another intervention for preventing OHSS in ART. Primary outcome measures were incidence of moderate or severe OHSS and live birth rate. Secondary outcomes were rates of clinical pregnancy, multiple pregnancy, miscarriage, and adverse events. Two review authors independently screened titles, abstracts, and full texts of publications; selected studies; extracted data; and assessed risk of bias. We resolved disagreements by consensus. We reported pooled results as odds ratios (OR) and 95% confidence interval (CI) by the Mantel-Haenszel method. We applied GRADE criteria to judge overall quality of the evidence. The search identified six new RCTs, resulting in 22 included RCTs involving 3171 women at high risk of OHSS for this updated review. Thedopamine agonists were cabergoline, quinagolide, and bromocriptine. Dopamine agonists versus placebo or no intervention Dopamine agonists probably lowered the risk of moderate or severe OHSS compared to placebo/no intervention(OR 0.32, 95% CI 0.23 to 0.44; 10 studies, 1202 participants; moderate-quality evidence). This suggests that ifthe risk of moderate or severe OHSS following placebo/no intervention is assumed to be 27%, the risk following dopamine agonists would be between 8% and 14%.We are uncertain of the effect of dopamine agonists on rates of live birth(OR 0.96, 95% CI 0.60 to 1.55; 3 studies, 362 participants; low-quality evidence). We are also uncertain of the effect of dopamine agonists onclinical pregnancy, multiple pregnancy,miscarriageor adverse events(very low to low-quality evidence). Dopamine agonists plus co-intervention versus co-intervention Dopamine agonist plus co-intervention (hydroxyethyl starch, human albumin, or withholding ovarian stimulation 'coasting') may decrease the risk of moderate or severe OHSS compared to co-intervention(OR 0.48, 95% CI 0.28 to 0.84; 4 studies, 748 participants; low-quality evidence). Dopamine agonists may improve rates of live birth(OR 1.21, 95% CI 0.81 to 1.80; 2 studies, 400 participants; low-quality evidence). Dopamine agonists may improve rates of clinical pregnancyandmiscarriage, but we are uncertain if they improve rates ofmultiple pregnancy or adverse events (very low to low-quality evidence). Dopamine agonists versus other active interventions We are uncertain if cabergoline improves the risk of moderate or severe OHSScompared to human albumin (OR 0.21, 95% CI 0.12 to 0.38; 3 studies, 296 participants; very low-quality evidence), prednisolone (OR 0.27, 95% CI 0.05 to 1.33; 1 study; 150 participants; very low-quality evidence), hydroxyethyl starch (OR 2.69, 95% CI 0.48 to 15.10; 1 study, 61 participants; very low-quality evidence), coasting (OR 0.42, 95% CI 0.18 to 0.95; 3 studies, 320 participants; very low-quality evidence), calcium infusion (OR 1.83, 95% CI 0.88 to 3.81; I² = 81%; 2 studies, 400 participants; very low-quality evidence), or diosmin (OR 2.85, 95% CI 1.35 to 6.00; 1 study, 200 participants; very low-quality evidence). We are uncertain of the effect of dopamine agonists on rates oflive birth(OR 1.08, 95% CI 0.73 to 1.59; 2 studies, 430 participants; low-quality evidence). We are uncertain of the effect of dopamine agonists on clinical pregnancy, multiple pregnancy or miscarriage (low to moderate-quality evidence). There were no adverse events reported. Dopamine agonists probably reduce the incidence of moderate or severe OHSScompared to placebo/no intervention, while we are uncertain of the effect onadverse events andpregnancy outcomes (live birth, clinical pregnancy,miscarriage). Dopamine agonists plus co-intervention may decrease moderate or severe OHSS rates compared to co-intervention only, but we are uncertain whether dopamine agonists affect pregnancy outcomes. When compared to other active interventions, we are uncertain of the effects of dopamine agonists on moderate or severe OHSS and pregnancy outcomes.

Effect of Goal-Directed Crystalloid versus Colloid Administration on Perioperative Hemostasis in Partial Hepatectomy: A Randomized, Controlled Trial.

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.

Starch-based magnetic nanocomposite for targeted delivery of hydrophilic bioactives as anticancer strategy

Magnetic nanocomposites were synthesized for the targeted delivery of hydrophilic bioactives through guidance generated by a magnetic field. Superparamagnetic iron oxide nanoparticles (SPIONs) were used to generate hydroxyethyl starch magnetic nanocapsules (HES MNCs). This synthesis allowed the co-encapsulation of oncocalyxone A (onco A) and surface-modified magnetite nanoparticles (Fe3O4@citrate) into the same nanostructure. The synthesized nanocapsules exhibited a core-shell morphology, with an average diameter of 143 nm. This nanocomposite showed potential anticancer activity (IC50) against four human tumor cell lines: glioblastoma SNB-19 (1.010 μgmL−1), colon carcinoma HCT-116 (2.675 μgmL−1), prostate PC3 (4.868 μgmL−1), and leukemia HL-60 (2.166 μgmL−1). Additionally, in vivo toxicity and locomotor activity were evaluated in a zebrafish (Danio rerio) model. The nanocomposite exhibited in vitro cytotoxicity, prolonged drug release profile and also responded to an applied magnetic field, representing a versatile compound with perspectives for highest concentration of different hydrophilic bioactives in a target tissue through magnetic vectorization.

EFFECT OF COLLOID VS CRYSTALLOID PRELOAD ON HEMODYNAMIC STABILITY IN ELDERLY PATIENTS UNDERGOING LOWER LIMB ORTHOPEDIC SURGERY UNDER SPINAL ANESTHESIA

Background: Hypotension is commonly occurred with Spinal anesthesia. Colloids and Crystalloids are used preoperatively to prevent hypotension. Objective: To examine the effect of fluid (crystalloid vs. colloid) preloading on hemodynamic stability in old patients planned for lower limb orthopedic operations with spinal anesthesia. Patients and methods: Eighty patients undergoing orthopedic surgery under spinal anesthesia were included in this work. Their age ranged between 60-80 years. Patients were allocated randomly to either Crystalloid (Ringer solution RS group) or Colloid (hydroxyethyl starch solution HES group). Intravenous preload of 10 mL/kg of either lactated Ringer's solution in the RS group or hydroxyethyl starch solution (6% HES 130/0.4; Voluven) in the HES group was infused over 20 min before spinal anesthesia.. Hemodynamic parameters were recorded, and all results were compared. Results: More than 20% drop in systolic blood pressure occurred in 45% patients in the crystalloid group compared to 15% patients in the colloid group. This difference was significant statistically (p < 0.01). Regarding requirement of ephedrine to treat hypotension, (45% of patients in crystalloid group required Ephedrine compared to 15% patients in colloid group). This was also statistically significant (p < 0.01). Conclusion: Colloid solution was better than crystalloid solution in controlling blood pressure, ephedrine requirements and heart rate changes.

Post-Cryo Survival of Rat Testicular Interstitial Cells in Hydroxyethyl Starch-Based Media

The development of cryoprotective serum-free or xeno-free media is required for safe use of cryopreserved testicular material for transplantation. In this study, the solutions containing 10% fetal bovine serum (FBS) or 5 mg/ml bovine serum albumin (BSA) did not significantly enhance the general survival of interstitial cells (ICs) after cryopreservation but increase their metabolic activity and steroid producing cell (HSD+-cells) survival. The use of 50 and 100 mg/ml hydroxyethyl starch (HES) in DMSO-based cryoprotective solutions instead of BSA or FBS enabled the improvement of the IC general survival and the survival of HSD+-cells. The use of HES supplemented media allowed to decrease the dimethyl sulfoxide (DMSO) concentration from 1.4 to 0.7 M and to preserve the amount and metabolic activity of ICs. Thus, designing cryoprotective media containing DMSO and HES can facilitate the formulation of serum-free solutions for cryopreservation that in turn paves a way for implementation of the use of cryopreserved material for practical medicine.

Venous thromboembolism prophylaxis for women at risk during pregnancy and the early postnatal period.

Venous thromboembolism prophylaxis for women at risk during pregnancy and the early postnatal period.

Comparison of hydroxyethylstarch 130/0.4 and ringer’s lactate on fibrinogen level in caesarean operations: a randomized clinical trial

COMPARISON OF HYDROXYETHYLSTARCH 130/0.4 AND RINGER’S LACTATE ON FIBRINOGEN LEVEL IN CAESAREAN OPERATIONS: A RANDOMIZED CLINICAL TRIAL&#x0D; Background and Aim:&#x0D; Colloids are effective in volume resuscitation but they have been shown to have negative impacts on fibrin formation. The aim of this study is to evaluate the effect of using low dose HES solutions on fibrinogen level in caserean operations.&#x0D; Materials and methods: &#x0D; 100 women, scheduled for Caserean surgery with spinal anesthesia were enrolled in the study. Patients were assigned to receive hydroxyethyl starch (HES) 130/0.4 in addition to a basic infusion of Ringer’s lactate (RL) solution (GROUP HES) or exclusively RL solution throughout the intraoperative study period (GROUP RL). Patients in the Group HES received HES 130/0.4 8 ml.kg-1h-1 with RL solution 5 mL.kg-1.h-1 and Group RL received RL solution 20 mL kg-1.h-1. Fibrinogen, haemoglobin, platelet values were recorded preoperatively and at postoperative first hour.&#x0D; Results:&#x0D; HES 130/0.4 was used only in Group HES, amount consumed was 418 ± 90 mL. Ringer’s lactate consumption was 276 ± 58 mL for Group HES and 1197 ± 197 mL for Group RL. There was a significant change in haemoglobine and fibrinogen values before and after surgery between groups. The mean decrease in fibrinogen was 92.18 ±60.12 mg/dL in Group HES and 65.70 ± 83.61 mg/dL in Group RL.&#x0D; Conclusion:&#x0D; HES 130/0.4 solution can be used in elective Caeserean operations without predicted or active hemorrhage. When there is a hemorrhage of any reason in HES 130/0.4 used cases, the decrease in fibrinogen level must be anticipated and rapid replacement of fibrinogen must be kept in mind.

Hydroxyethyl Starch-Based Functionalization of Gold Nanorods: A Possible Alternative to Polyethylene Glycol as a Surface Modifier

PEGylation refers to the process of functionalizing nanoparticles with polyethylene glycol (PEG) to avoid unspecific uptake by the mononuclear phagocyte system and prolong the circulation half-life of nanomedicines. Immunogenicity and nonbiodegradability are the major limitations in PEGylation that can be resolved by substituting PEG with biofriendly polymers, such as hydroxyethyl starch (HES). In the current study, thiolated hydroxyethyl starch (HES-SH, 130/0.4) was harnessed to stabilize gold nanorods (AuNRs) and compared with PEG-SH-coated AuNRs at different aspects of characterization and photothermal analysis. Our results confirm that AuNRs were functionalized successfully with both HES-SH and PEG-SH, where the initial spectra and colloidal stability of gold nanorods were restored after functionalization. In addition, the photothermal conversion stability of gold nanorods was maintained during both HESylation and PEGylation without affecting the heat generation. In summary, we presume that HES-SH can be used as a surface modifier to stabilize gold nanorods and might be used as a promising alternative to PEG.

Poloxamer 188 and hydroxyethyl starch have a cryoprotective synergic effect improving post-thawing quality and fertility of rooster spermatozoa

Poloxamer and hydroxyethyl starch have cytoprotective effects. In the present study, effectiveness was evaluated of these compounds as a cryoprotectant for rooster semen. In Experiment 1 (E1), poloxamer 188 (1%, P188), poloxamer 407 (1%, P407), and control groups were compared after sperm cryopreservation. Experiment 2 (E2) was conducted with 3%, 5%, and 7% of hydroxyethyl starch (H3, H5, H7), also combined with P188 (H3P188, H5P188, H7P188), based on results from E1. Sperm motility was assessed using CASA, abnormal forms and hypo-osmotic swelling (HOS) were evaluated using microscopy, and viability, apoptotic-like changes, and mitochondrial activity were determined using flow cytometry. In E2, there were assessments of fertility and hatching capacity. Results from E1 indicated total and progressive motility, velocity, membrane functionality, viability, and mitochondrial activity were greater with inclusion of P188 in semen extender, with less apoptotic-like changes (P < 0.05). In E2, HES inclusion in semen extender improved total motility, membrane functionality, and mitochondrial activity (P < 0.05), especially H5, which also markedly increased sperm viability and decreased apoptotic-like changes. The combination of P188 with HES increased sperm quality overall, with inclusion of H5P188 resulting in increases of progressive motility and VSL (P < 0.05). The H5 inclusion also increased proportion of fertilized eggs (P < 0.05). Furthermore, the combination of HES and P188 increased proportions of fertilized and hatched eggs compared with the control, with inclusion of H5P188 having the greatest effects. In conclusion, supplementation of semen extender with H5P188 increases post-thawing quality and fertility of rooster sperm, being a safe and effective method for the poultry industry.

Prospective randomized controlled blinded clinical trial evaluating biomarkers of acute kidney injury following 6% hydroxyethyl starch 130/0.4 or Hartmann's solution in dogs.

To evaluate the effect of 6% hydroxyethyl starch (HES) 130/0.4, compared with a Hartmann's solution control (CRYST), on urine biomarkers of acute kidney injury (AKI) in dogs prescribed a fluid bolus. Randomized, controlled, blinded clinical trial January 2018 to February 2019. University teaching hospital. Forty client-owned dogs. Dogs prescribed a fluid bolus were randomized to receive at least 10mL/kg of HES or CRYST with clinicians and investigators blinded to fluid type. Study fluid was used for further boluses as required in the following 24hours, to a limit of 40mL/kg total, after which fluid administration was open-label. Urine was collected prior to and 6, 12, and 24hours after the first study fluid bolus. Urine concentrations of AKI biomarkers: neutrophil gelatinase-associated lipocalin (NGAL), cystatin C, kidney injury molecule-1 (KIM), clusterin, and osteopontin were measured using a magnetic bead multiplexed assay. Osmolality-indexed biomarker concentrations were compared between groups over time with linear mixed-effects models, with P<0.05 considered significant. The mean volume of study fluid administered was not significantly different between groups (HES: 23.1mL/kg, CRYST: 25.9mL/kg; P=0.47, t-test). There were no significant differences between groups in change over time of osmolality-indexed urine concentrations of NGAL (P=0.91), cystatin C (P=0.95), KIM (P=0.77), clusterin (P=0.63), or osteopontin (P=0.91). The maximum Veterinary Acute Kidney Injury (VAKI) score up to 7 days during hospitalization (P=1.0) and in-hospital mortality (P=0.49) were not significantly different between groups, as compared by Fisher's exact test. There were no differences in change over time of urine AKI biomarkers in dogs treated with 10 - 40mL/kg HES or CRYST over 24hours. Larger clinical trials with patient-centered outcomes are required to investigate the safety of HES in dogs.

Clinical Outcomes and Medical Costs of Hydration Therapy with Hydroxyethyl Starch (130/0.4) or Acute Single Infarction

ObjectivesTo investigate the effects of hydration with or without Hydroxyethyl Starch (HES) 130/0.4 on neurological outcomes and medical costs during hospitalisation in patients with a single infarction (SI) in the posterior lenticulostriate artery (LSA) territory. Materials and methodsIn this retrospective, single-centre, non-blinded cohort study, SI in the posterior LSA was defined as an ischaemic lesion with a high-signal intensity area ≥20 mm. All patients received basic stroke care within 48 h of symptom onset between April 2015 and January 2019. Patients were divided into the following two groups by clinician's preference: 1) those administered HES 130/0.4 and 2) those receiving other infusion fluid. The relationships between hospital costs and hydration therapy type were examined. ResultsEighteen (31%) of 58 patients received HES 130/0.4. The HES group had a significantly lower total cost than the control group (3.6 vs. 6.4 million yen, p=0.006). Moreover, the HES group had a significantly shorter hospital stay duration (79.5 vs. 141.0 days) and lower National Institutes of Health Stroke Scale score on day 7. Multivariate analysis found that HES 130/0.4 administration was an independent factor associated with high costs. ConclusionsHydration therapy with HES 130/0.4 significantly decreased the total costs and hospitalisation duration of patients with SI in the posterior LSA territory.

The effect of tetrastarch solution for capillary leak syndrome following allogeneic hematopoietic stem cell transplantation: A report of 2 cases.

Capillary leak syndrome (CLS) is a severe complication of allogeneic hematopoietic stem cell transplantation (HSCT) characterized by weight gain, generalized edema, hypotension, and hypoalbuminemia. The primary pathogenesis is injury of the capillary endothelium resulting in a loss of intravascular fluid into the interstitial space. Treatment is limited to vascular endothelial growth factor withdrawal and systemic corticosteroids. We report two cases with CLS where weight gain, ascites, and hypotension developed after neutrophil engraftment following allogeneic HSCT. We obtained serial electrolytes, blood urea nitrogen, creatinine, and albumin from these patients. Ultrasound with Doppler tracing performed on both patients showed no reversal of portal venous flow. Issues addressed were the restoration of regular hydration by hydroxyethyl starch (HES) solutions, together with systemic corticosteroids and forced diuresis. Tetrastarch was administered 10 and 20 days, respectively. Both patients recovered without sequelae. CLS is a frequent complication after allogeneic HSCT. The effects of HES on CLS merit further consideration and prospective study.

O024 / #948: DOES A BALANCED COLLOID DECREASE PERIOPERATIVE BLOOD LOSS IN PEDIATRIC CARDIAC SURGERY: A DOUBLE-BLINDED RANDOMIZED CONTROLLED TRIAL?

Aims & Objectives: Unbalanced fluid solutions cause metabolic acidosis and could therefore be associated with impaired coagulation and increased blood loss. Our hypothesis is that the use of a balanced colloid for perioperative fluid therapy compared to a saline colloid is associated with decreased blood loss and exposure to blood products. Methods: This double blinded randomized controlled trial was conducted at a tertiary children hospital. Children older than 29 days and younger than 3 years admitted for cardiac surgery with cardiopulmonary bypass (CPB). Exclusion criteria were: emergency surgery; moribund, Jehovah witnesses, coagulopathy, renal or liver failure, intracranial hemorrhage, and electrolyte disturbances. Patients were randomly assigned to either a saline colloid (6% hydroxyethyl starch in NaCl 0.9%) or a balanced colloid (6% hydroxyethyl starch in an isotonic solution) for CPB priming and intra- and postoperative fluid therapy during the first postoperative 48 hours. Results: Eighty-nine patients were included in the study (45 in the Saline colloid and 44 in the Balanced colloid group). The primary outcome measure, calculated blood loss at postoperative day (POD3) was not significantly different between the two groups [Saline colloid: 20.7 (14.3-27.6) ml kg-1 versus Balanced colloid: 17.6 (8.6-26.0); P=0.236]. Secondary outcomes related to bleeding, exposure to blood products and coagulation were not different between groups. There was also no difference in length of mechanical ventilation, intensive care and hospital length of stay between groups. Conclusions: The use of a balanced colloid for perioperative fluid therapy compared to a saline one is not associated with decreased blood loss and exposure to blood products

Effects of hydroxyethyl starch and gelatin on the risk of acute kidney injury following orthotopic liver transplantation: A multicenter retrospective comparative clinical study.

ObjectivesThis multicenter retrospective study aimed to compare the effects of HES and gelatin (GEL) on the risk of post-OLT AKI.MethodA total of 1,672 patients undergoing OLT were enrolled from major transplant centers in China between 2005 and 2013. These patients were divided into three groups: GEL, hydroxyethyl starch (HES), and GEL + HES group.ResultsThere was no significant difference in the incidence of post-OLT AKI among the GEL, HES, and GEL + HES groups. The GEL + HES group had a lower incidence of stage II post-OLT AKI than the other two groups. Compared with patients receiving GEL, patients receiving HES did not harbor an increased risk of AKI. Our results showed that MELD score (adjusted odds ratio [OR], 1.579; 95% confidence interval [CI], 1.123–2.219; P = 0.009) and preoperative anemia (adjusted OR, 1.533; 95% CI, 1.212–1.939; P < 0.001) were independent risk factors for post-OLT AKI, and normal preoperative Scr level (vs abnormal; adjusted OR, 0.402; 95% CI, 0.222–0.729; P = 0.003) was independent protective factors for post-OLT AKI.ConclusionThis large-scale multicenter retrospective study found that the intraoperative use of HES did not increase the overall incidence of post-OLT AKI in patients when compared with GEL, and whether to increase the risk of post-OLT AKI needs to be further explored.