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Colloid versus Crystalloids
Published in Stephen M. Cohn, Alan Lisbon, Stephen Heard, 50 Landmark Papers, 2021
Artificial colloids such as 6% hydroxyethyl starch (HES) should be avoided. In one prospective randomized study comparing HES to NS, the incidence of AKI necessitating RRT was higher in the HES group. There was no difference in mortality. A meta-analysis comparing HES to other standard resuscitation regimens found that HES was associated with higher mortality and need for RRT. Notably, seven trials associated with scientific misconduct were excluded from that study. Those seven trials reported favorable effects of HES. HES is still on the market, but its use has plummeted as a consequence of these and other unfavorable data.
Acquired Bleeding Disorders Associated with Disease and Medications
Published in Harold R. Schumacher, William A. Rock, Sanford A. Stass, Handbook of Hematologic Pathology, 2019
William A. Rock, Sue D. Walker
Hetastarch (hydroxyethyl starch) is a synthetic glucose polymer that is used for plasma expansion. For the same reasons as with dextran, hetastarch may prolong the bleeding time. Volumes exceeding 1 L in an average adult may result in prolongation of the PT and aPTT. This prolongation is not always associated with bleeding, but in surgical or trauma patients the cause for bleeding is not always clear. The prolongation in the PT and APTT is not always associated with bleeding and may occur before an actual defect in coagulation is present (137).
Intimidation, threats and violence to protect sales
Published in Peter C. Gøtzsche, Richard Smith, Drummond Rennie, Deadly Medicines and Organised Crime, 2019
Peter C. Gøtzsche, Richard Smith, Drummond Rennie
In 2012, other Danish researchers came in trouble. They had shown in a publicly funded trial that hydroxyethyl starch, a plasma expander used in patients with severe sepsis, kills the patients, compared to giving them a much cheaper balanced salt solution.12 When the study was published in the New England Journal of Medicine, a letter was promptly sent by the lawyers for Fresenius Kabi AG.13 The lawyers wrote that ‘Fresenius Kabi AG is prepared to take all appropriate legal action to recover the economic losses it has suffered (and will continue to suffer) as a result of the false information you and your colleagues have reported’ and called for immediate withdrawal of the paper and correction to be made within 2 days. This was ludicrous. The researchers had written ‘HES 130/0.4’ in their paper but should have written ‘HES 130/0.42’ Did you notice the difference? If we round 0.42 to one less decimal, we’ll get 0.4, won’t we? The issue is that these two designations refer to two slightly different versions of hydroxyethyl starch, sold by two different companies, and the researchers had not studied Fresenius’ product but the other one.
Rituximab induces a flare-up of activated neutrophil extracellular traps under in vitro conditions
Published in Immunopharmacology and Immunotoxicology, 2022
Joerg Hoffmann, Samira Roesner, Andreas Neubauer
Complete blood count was obtained from all samples (Sysmex XS-1000i, Sysmex Corporation, Kobe, Japan). Afterwards 1 ml 6% hydroxyethyl starch (Fresenius Kabi, Bad Homburg, Germany) was added to the samples. Erythrocytes were allowed to sediment for 30 min at room temperature and leukocytes were harvested from the top layer. After a washing step white blood cells were seeded in 2 ml wells of a cell culture plate (Sarstedt, Nümbrecht, Germany) with prewarmed cell culture medium (RPMI 1640, Thermo Fisher Scientific, Waltham, MA) and 2% fetal calf serum (FCS; PAN-Biotech, Aidenbach, Germany). To stimulate NET formation, leukocytes were incubated 30 min with 4 µM ionomycin I3909 (Sigma-Aldrich, St. Louis, MO) at 37 °C and 5% CO2. Parallel to ionomycin incubation the leucocytes were exposed to different drugs as follows: 10 µM dexamethasone (Dexamethason-ratiopharm®, Ratiopharm, Ulm, Germany), 5 nM acetylsalicylic acid (Aspirin®, Bayer, Leverkusen, Germany), 20 µM etoposide (Eto-GRY®, Teva, Parsippany, NJ), 20 nM bortezomib (Velcade® Janssen Pharmaceutica NV, Beerse, Belgium), or 10 µg/ml rituximab (MabThera®, Hoffman-La Roche, Basel, Switzerland). For each drug and patient positive control was tested in replicates of two. Negative controls without drug exposure were performed with ionomycin stimulation and without ionomycin stimulation.
A deadly capillary leak attack. Clarkson’s disease: a narrative review
Published in Acta Clinica Belgica, 2022
E De Tandt, D Van Sassenbroeck, L Heireman, J Dierick, A Luyckx, S Verelst
Because of the similarities at presentation with a hypovolemic/distributive shock, the first treatment consists of targeted fluid resuscitation. Inadequate resuscitation can lead to stroke, other end-organ ischemia and even death, while overzealous fluid resuscitation can lead to anasarca, pulmonary edema and compartment syndrome [4,11,12,15]. Therefore, the volume status of the patient must be carefully monitored. In addition, haemodynamic monitoring remains crucial during the whole episode because of the lurking transitioning from the leaking phase to the recovery phase. Crystalloids are the fluids of choice. When insufficient, albumin or other colloids can be considered. However, the efficacy of albumin is expected to be attenuated due to the ongoing albumin loss which could have a counterproductive effect. Although hydroxyethyl starch solutions have been associated with an increased mortality and acute kidney injury in critically ill patients, the potential benefit of starches probably outweighs the risk in ISCLS patients with refractory shock [7,25].
Phases of fluid management and the roles of human albumin solution in perioperative and critically ill patients
Published in Current Medical Research and Opinion, 2020
Giving fluid therapy to restore and maintain tissue perfusion is standard practice for patients with critical illness or those undergoing surgery1. Significant risks of fluid therapies are related to under- or over-administration, as well as their pharmacological side effects. Every day, more than 20% of patients in intensive care units (ICUs) are treated with intravenous fluids; more than 30% receive fluids for volume resuscitation on day 12. In the past, colloid solutions have been used more frequently than crystalloid solutions for volume resuscitation; however, colloids cost more and some are potentially harmful3. Today, more crystalloid solutions are used, often buffered solutions instead of saline, and solutions of the natural colloid albumin are favored over synthetic colloid solutions, particularly hydroxyethyl starch (HES)4–7.