Anestéziológia a intenzívna medicína 2/2013

Colloid hydroxyethylstarch solutions – indications, contraindications of its use in anesthesiology, perioperative and intensive medicine

The review is devoted to the clinical use of colloid solutions in hypovolemic patients. We analyzed the risk/benefit ratio of colloid hydroxyetylstarch solutions when infused to the critically ill patients. Robust randomized controlled trials as VISEP, 6S and CHEST have shown, that liberal, overused and prolonged adiministration of hydroxyetylstarch solutions increased the letality of patients and incidence of acute kidney failure with renal replacement therapy. Hydroxyetylstarch solutions was harmful for coagulation system, increased bleeding, hemodilution and hepatic dysfunction. In opposite, other randomized clinical studies like BaSES, CRYSTMAS and CRISTAL have demonstrated positive effects of hydroyetylstarch solutions on hemodynamics, and clinical utility when using for the therapy of acute hypovolemia without deleterious influence on renal functions. In the review we suggest some limitations in indications of therapy of hypovolemia with starch colloids, time and dose restrictions, careful and rationale use of isooncotic hydroxyetlystarchs solutions in perioperative and intensive medicine.

Keywords: colloid solutions, hydroxyethylstarch, acute hypovolemia, intensive medicine.