Abstract
Plasma substitutes are mainly used to maintain circulating blood volume during massive hemorrhage. These solutions are used to bridge the gap between fluid therapy with crystalloid and that with albumin since plasma substitutes are usually less expensive than albumin while large doses of such synthetic colloids may negatively affect the coagulation system and renal integrity. Since an effective coagulation system depends on the presence of large HES molecule in the circulation, middle-molecular-weight, rapidly degradable hydroxyethyl starch (HES) is generally used for the treatment of massive hemorrhage. Recent randomized controlled trials revealed that middle-molecular-weight, rapidly degradable HES significantly increased the risk of renal injury in critically ill patients. Such studies are characterized by the repetitive administration of HES at the high end of the daily allowable limit. In contrast, better renal effects were reported when middle-molecular-weight, rapidly degradable HES was used for trauma resuscitation. Based on these data, we assume that HES use against massive hemorrhage is safe when used for resuscitative purposes within the allowable limit.
