China 
Africa 
Explore chapters and articles related to this topic
Transfusion practice in resuscitation and critical illness
Published in Jennifer Duguid, Lawrence Tim Goodnough, Michael J. Desmond, Transfusion Medicine in Practice, 2020
The practice of administering human albumin solution – once considered the optimal, albeit expensive, volume expander in critically ill patients – has recently been questioned as a result of a single study. However, this study has been severely criticized, and it would be inappropriate to alter clinical practice as a result. Despite well over a decade of research and evidence of improved outcome in some patient groups, the enthusiasm for using hypertonic fluids remains limited. Minimal-volume resuscitation has been demonstrated to reduce haemorrhage and improve outcome in patients with penetrating truncal injuries and leaking abdominal aortic aneurysms, but its use for other patients has not been substantiated. The decision to transfuse blood during the early phases of resuscitation should not be taken lightly, since there is evidence of an increased incidence of detrimental sequelae.
General plastic
Published in Tor Wo Chiu, Stone’s Plastic Surgery Facts, 2018
Dextran 40 is a volume expander with beneficial effects on microcirculation – theories for this include the negative charge on platelets reducing adhesiveness and inactivation of vWF. There is a small risk of anaphylaxis/allergy, and test doses are recommended, though not often followed. It is commonly used as a 250 mL bolus, followed by an infusion of 20 mL/hour (500 mL/24 hours). Although there were some good animal studies, clinical evidence remains lacking, particularly of its usefulness in uncomplicated anastomosis.
Ascites and Peritonitis
Published in John F. Pohl, Christopher Jolley, Daniel Gelfond, Pediatric Gastroenterology, 2014
Candi Jump, Douglas Moote, Wael N. Sayej
Albumin is a plasma volume expander that improves arterial hypotension. Patients with hepatic impairment can be albumin deficient secondary to loss of the liver’s synthetic function. The use of intravenous albumin has been shown to improve diuretic response, decrease the need for paracentesis, and reduce the length of hospital stay and need for readmission in patients with ascites. Traditionally, 5% albumin infusions are used to expand the intravascular volume and to provide albumin. Studies have shown that hemodynamic instability, which is usually seen in large volume paracentesis, is uncommon, and thus volume expansion is usually not necessary. The use of 25% albumin infusions (0.5–1.0 g/kg dry weight) has become the standard of care for both adult and pediatric patients. An alternative plasma volume expander is dextran 70 which has been shown to have similar efficacy to albumin infusions.
Is a hyperosmolar pump prime for cardiopulmonary bypass a risk factor for postoperative delirium? A double blinded randomised controlled trial
Published in Scandinavian Cardiovascular Journal, 2023
Helena Claesson Lingehall, Yngve Gustafson, Staffan Svenmarker, Micael Appelblad, Fredrik Davidsson, Fredrik Holmner, Alexander Wahba, Birgitta Olofsson
The hyperosmolar pump prime produced a lower net volume fluid balance, which is believed to protect against POD [2,21,22]. The inclusion of mannitol increased the urine output, which is one explanation for the more favourable fluid balance. The other is related to the osmotic effects generated by the combination of mannitol and sodium chloride. From a physiological viewpoint, this is explained by the shift of water from the interstitial and intracellular compartments into the plasma volume. As a result, it will lower the requirement of extra fluids during CPB to maintain a normal circulatory blood volume. This is indicated by the significantly lower haematocrit level measured during CPB. The negative consequences of using body water as plasma volume expander are the effects it might have on organ function, especially the brain. While commencing CPB, the volume of 1400 mL is introduced intra-arterially in close connection of the cerebral circulation over a time-period less than 3 min, with an osmolality threefold higher than normal. Of note is that hyperosmolality is seldom suspected to cause POD, but should be considered. In the worst scenario, it may lead to osmotic demyelination [23]. It may also shrink glia cells [24], especially if the blood–brain barrier is disrupted, which is common after cardiac surgery [25].
Pharmaceutical, biomedical and ophthalmic applications of biodegradable polymers (BDPs): literature and patent review
Published in Pharmaceutical Development and Technology, 2022
Barzan Osi, Mouhamad Khoder, Ali A. Al-Kinani, Raid G. Alany
Dextran is a linear polysaccharide consisting of −1,6 linked D-glucopyranose residues with a few percent of −1,2, −1,3, or −1,4-linked side chains, originally derived from wine (Khoder et al. 2018). Dextran exhibits several favourable biological properties, such as biocompatibility, biodegradability, and non-toxicity (Ali and Ahmed 2018). In addition, it is very stable under mild acidic and basic conditions and highly water-soluble substance. For decades, this glucose-based polymer has been used clinically as a plasma volume expander (Irimia et al. 2018), peripheral flow enhancer (Li et al. 2018), antithrombotic agent (Mello et al. 2006). Furthermore, in ophthalmic applications dextran is often used as the active ingredient in eye drops due to its lubricating nature or as artificial tears (Garg et al. 2019) such as GenTeal® Lubricant Eye Drops, Tears Naturale® eye drops (Alcon Eye Care UK Limited).
Impaired albumin function: a novel potential indicator for liver function damage?
Published in Annals of Medicine, 2019
Lejia Sun, Huanhuan Yin, Meixi Liu, Gang Xu, Xiaoxiang Zhou, Penglei Ge, Huayu Yang, Yilei Mao
Human serum albumin (HSA) is the most abundant protein (Sleep 2015) in healthy individuals and it plays an important role in maintaining plasma colloid osmotic pressure. Therefore, it has been used as a volume expander since the 1940s (Garcia-Martinez et al. 2013; Vincent et al. 2014). However, over the past few decades, an increasing number of studies have demonstrated that HSA is a multifunctional protein (Fanali et al. 2012; Shalish et al. 2017; Setoyama et al. 2017; Kawakami et al. 2006) with roles in the binding and transport of endogenous and exogenous molecules (Sleep 2015), anti-oxidation and anti-inflammation, endothelial stabilisation, anti-thrombosis, and the adjustment of capillary permeability. It has been shown that albumin infusion can improve the prognosis of patients with spontaneous peritonitis (Sort et al. 1999; Jamtgaard, Manning, and Cohn 2016) or hepatorenal syndrome (Ortega et al. 2002; Martin-Llahi et al. 2008), not only via plasma volume expansion, but also because of its non-colloid osmotic function. However, the clinical significance of the non-oncotic functions of HSA has not been investigated in detail. It is likely that albumin function is altered during liver dysfunction, and recent studies (Jalan et al. 2009; Oettl et al. 2013) have shown that the three-dimensional structure of albumin is modified, along with its function, in liver diseases, and that these modifications are related to the specific clinical features and severity of the disease, and the prognosis.