Changes in circulating blood volume after infusion of hydroxyethyl starch 6% in critically ill patients

• Published in: Acta anaesthesiologica Scandinavica 2001-04, Vol.45 (4), p.414-420
• Main Authors: Christensen, P., Andersson, J., Rasmussen, S. E., Andersen, P. K., Henneberg, S. W.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Algorithms; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood volume; Blood Volume - drug effects; Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis; carbon monoxide; Carbon Monoxide - blood; colloids; Critical Illness; Female; Hematocrit; Humans; hydroxyethyl starch; Hydroxyethyl Starch Derivatives - pharmacology; intensive care; Male; Medical sciences; Middle Aged; Plasma Substitutes - pharmacology; plasma volume; Transfusions. Complications. Transfusion reactions. Cell and gene therapy
• ISSN: 0001-5172; 1399-6576
• DOI: 10.1034/j.1399-6576.2001.045004414.x

Background: The cardiovascular response to a volume challenge with hydroxyethyl starch (HES) (200/0.5) 6% depends on the relation between the volume of HES 6% infused and the expansion of the blood volume in critically ill patients. However, only relatively limited data exist on the plasma expanding effect of infusion of HES 6% in critically ill patients. The purpose of the study was to evaluate the variation in the expansion of the circulating blood volume (CBV) in critically ill patients after infusion of 500 ml of colloid (HES (200/0.5) 6%) using the carbon monoxide method. Methods: In 20 consecutive patients admitted to the ICU requiring mechanical ventilation and volume expansion, 500 ml of HES (200/0.5) 6% was infused. The CBV was measured immediately before the infusion, 10 min after completing the infusion and then hourly for 8 h. Results: The median volume expansion immediately after infusion was 470 ml (range 270 ml to 840 ml). The corresponding values after 4 h and 8 h were 265 ml (range −30 ml to 460 ml) and 120 ml (range −210 ml to 360 ml), respectively. The increase in CBV was only statistically significant for 4 h. The coefficient of variation of the method for estimation of CBV was 3.6%. Conclusions: The large interindividual variation of the volume expansion after infusion of HES 6% in critically ill patients illustrates one of the difficulties in optimizing colloid therapy and interpretating the changes in hemodynamic variables after a colloid challenge.