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Review Article |

A Systematic Review of the Comparative Safety of Colloids FREE

Michael E. Barron, MD; Mahlon M. Wilkes, PhD; Roberta J. Navickis, PhD
[+] Author Affiliations

From the Department of Anesthesiology, University of Miami School of Medicine, Miami, Fla (Dr Barron); and Hygeia Associates, Grass Valley, Calif (Drs Wilkes and Navickas). Dr Barron is a consultant/lecturer for the American Red Cross.


Arch Surg. 2004;139(5):552-563. doi:10.1001/archsurg.139.5.552.
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Published online

Hypothesis  Safety differences exist among colloids widely used for fluid management in acutely ill patients, as judged according to the comparative incidence of adverse events.

Data Sources  Colloid safety data for human subjects were sought, without language or time period restrictions, by means of computer searches of bibliographic and clinical trial databases, hand searches of medical journals and Index Medicus, inquiries with investigators and colloid suppliers, and examination of reference lists. Search terms included "colloids", "morbidity", and "mortality".

Study Selection  Controlled trials, cohort studies, pharmacovigilance studies, and prior meta-analyses were independently selected by 2 unblinded investigators. Of 189 candidate studies, 113 were included, with safety data encompassing 1.54 × 106 patients and 1.09 × 108 colloid infusions.

Data Extraction  Two unblinded investigators independently extracted data. Study limitations and confounding factors were tabulated.

Data Synthesis  With albumin as the reference colloid, the incidence rate ratio for anaphylactoid reactions was 4.51 (95% confidence interval, 2.06-9.89) after hydroxyethyl starch administration, 2.32 (95% confidence interval, 1.21-4.45) after dextran, and 12.4 (95% confidence interval, 6.40-24.0) after gelatin. Pruritus occurrence was significantly increased by hydroxyethyl starch exposure (odds ratio, 1.78; 95% confidence interval, 1.23-2.58). Artificial colloid administration was consistently associated with coagulopathy and clinical bleeding, most frequently in cardiac surgery patients receiving hydroxyethyl starch. On the basis of large-scale pharmacovigilance study results, albumin infusion resulted in a low rate of both total adverse events (3.1 to 8.6 per 105 infusions) and serious adverse events (1.29 per 106 infusions).

Conclusions  Significant safety differences exist among colloids. Therefore, conclusions regarding the clinical usefulness of colloids as a fluid class should be formed with caution.

Colloids promote retention of fluid in the intravascular space, with concomitant reduction of the potential for edema that might compromise the function of organs such as the lungs, myocardium, and gastrointestinal tract.1 The chief colloids currently in routine clinical use worldwide are albumin, hydroxyethyl starch (HES), dextran, and gelatin. Clinically available albumin is a 69-kDa protein purified from human plasma. Hydroxyethyl starch is synthesized by partial hydrolysis of amylopectin plant starch and hydroxyethylation at the C2, C3, and C6 positions of the constituent glucose molecules. Dextran is composed of naturally occurring glucose polymers synthesized by Leuconostoc mesenteroides bacteria growing in sucrose-containing media. Gelatin for clinical use is derived from hydrolysis of bovine collagen followed by being either succinylated or linked to urea.

All 3 artificial colloids are polydisperse molecules in a range of sizes. Hydroxyethyl starch is clinically available in an array of forms differing on the basis both of average molecular weight and extent of molar substitution, although in the United States only the HES of high molecular weight (450 kDa) of 0.7 molar substitution ratio has been used in routine fluid management. In the United States, dextran is less extensively used for fluid management than is HES, and gelatin is unavailable for clinical use.

Clinically available colloids have generally exhibited similar effectiveness in maintaining colloid oncotic pressure. Thus, colloids have often been viewed as a class of essentially interchangeable inert fluids, and selection of colloid has commonly been based on cost and convenience. Nevertheless, differences in safety profiles among colloids are well recognized.2,3 Such differences underlie, for example, the recommended 1500 mL (20 mL per kilogram of body weight) dose limitation for HES.4

The clinical importance of differences in colloid safety has been debated. Firm conclusions have been difficult to draw, in part because comparative colloid safety has not been systematically reviewed. We here present the results of such a review.

INCLUSION CRITERIA

We systematically sought all studies of acutely ill patients with data on the safety of the natural colloid albumin and the artificial colloids HES, dextran, and gelatin. Randomized controlled trials (RCTs), nonrandomized controlled trials (NCTs), cohort studies, pharmacovigilance studies (PVSs), and meta-analyses (MAs) were eligible for inclusion.

SEARCH TECHNIQUES

Clinical studies fulfilling the selection criteria were identified, without language or time period restrictions, by computer searches of the MEDLINE and EMBASE bibliographic databases, the Cochrane Controlled Trials Register, and the Cochrane Medical Editors Trial Amnesty of unpublished trials. Search terms included "colloids", "morbidity", and "mortality". Hand searches were conducted of general medical journals and Index Medicus. We contacted the authors of published clinical studies related to colloids and the medical directors of colloid suppliers and examined the reference citations from completed reviews and protocols in the Cochrane Database of Systematic Reviews, other MAs, review articles, and controlled and uncontrolled studies involving colloids.

DATA EXTRACTION AND SYNTHESIS

Two unblinded investigators (M.M.W. and R.J.N.) independently selected studies for inclusion and extracted data about study design, numbers of patients enrolled and/or infusions administered, clinical setting, fluid regimen, and major study findings, as well as study limitations and confounding factors. Differences in interpretation were resolved through discussion.

STATISTICAL ANALYSIS

Study results were generally assessed qualitatively. However, quantitative MAs were performed of data for 2 end points: anaphylactoid reactions and HES-associated pruritus. The meta-analytic methodology was generalized mixed modeling with study-level random effects. Such models are intended to accommodate expected between-study heterogeneity.

The incidence rate ratio of anaphylactoid reactions with individual colloids, as compared with albumin as reference standard, was calculated together with the corresponding confidence interval (CI) by means of random-effects Poisson regression. Pruritus associated with HES was modeled by means of random-effects logistic regression. Results were expressed as the odds ratio for occurrence of HES-associated pruritus. For both incidence rate ratio and odds ratio, the absence of the number 1 from the CI signifies a statistically significant effect.

INCLUDED STUDIES

Of 189 candidate studies initially identified, 113 studies published from 1944 through 2002 were included.1303160619091113 One RCT was excluded because of fluid overload in the albumin group.114 Numbers of study patients, which were reported in 107 of the included studies, totaled 1.54 × 106 patients. The median number of patients per study was 60, with an interquartile range of 29 to 200. In the remaining 6 studies, the numbers of infusions were reported, and these totaled 1.09 × 108 infusions. The median number of infusions per study was 8.5 × 105 (interquartile range, 1.20-74.0 × 105). Safety data about albumin, HES, dextran, and gelatin were available from 60, 75, 17, and 25 included studies, respectively.

Twenty-one of the included studies involved acute illness generally (Table 1), 35 cardiac surgery (Table 2), 19 noncardiac surgery (Table 3), 5 ascites, 4 sepsis, 13 brain injury, 3 dialysis, 6 plasma exchange, and 7 acute hearing loss. (Tables summarizing studies of ascites, sepsis, brain injury, dialysis, plasma exchange, and acute hearing loss are available from the authors.) Of the cardiac surgery studies, 14 were evaluations of extracorporeal circuit pump priming; 19, volume expansion; and 2, both.

The most frequently represented study design was the RCT, which accounted for 54 studies. Twenty-eight studies were NCTs, 22 were cohort studies, 6 were PVSs, and 3 were MAs.

ALL ADVERSE EVENTS

In large-scale PVSs, the reported incidence for adverse events of any severity in albumin recipients was 6.1 to 6.8 per 105 infusions of 5% albumin and 3.1 to 8.6 per 105 infusions of 20% to 25% albumin.7,28 For serious adverse events, an incidence of 1.29 per 106 infusions was reported.111 The PVSs are generally based on spontaneous adverse event reporting and are subject to underreporting. One of these PVSs also included data for gelatin, and the reported incidence of adverse events was similar to that for albumin.7 In a cohort study of 379 patients, the incidence of all HES-associated adverse effects was 4.5%.42

MORTALITY

One MA of RCTs indicated poorer survival in critically ill patients receiving albumin vs crystalloid or no albumin.85 However, authors of a subsequent MA110 considered RCT evidence approximately 3-fold more extensive than that of the first MA, and there was no evidence of increased albumin-associated mortality. Results of higher quality trials suggested a potential survival benefit of albumin.110 Thus, in a multivariate analysis of blinded larger RCTs, mortality was significantly reduced by albumin (odds ratio, 0.78; 95% CI, 0.76-0.81). A large-scale PVS provided evidence that deaths after albumin administration are rare (5.24 per 108 infusions).111 Hemodilution with HES was investigated in 1 RCT of patients with acute ischemic stroke.32 The trial was stopped prematurely because of a significant increase in mortality related to cerebral edema among HES recipients.

ANAPHYLACTOID REACTIONS

In 9 studies, data were reported on anaphylactoid reactions after 3.63 × 106 total colloid infusions.2,5,6,8,16,26,57,75,84 The pooled incidence of anaphylactoid reactions after albumin administration was 9.44 per 105 infusions (95% CI, 5.04-17.7 per 105 infusions). Infusions of all 3 artificial colloids, as compared with albumin, were associated with significantly increased anaphylactoid reactions (Table 4).

Table Graphic Jump LocationTable 4. Pooled Incidence Rate Ratios for Anaphylactoid Reactions
PRURITUS

In 1 study, there was evidence of dextran-associated pruritus in some patients.45 Otherwise, however, reports of this adverse effect were restricted to HES exclusively. Pruritus associated with HES was reported in 14 studies involving a total of 2598 patients, of whom 2173 (83.6%) received HES and 425 (16.4%) did not.45,52,53,55,58,59,76,84,86,95,96,99,105,106 The odds of pruritus were significantly increased by HES exposure (Table 5). The effect of HES on pruritus occurrence depended on dose. Neither HES molecular weight nor HES molar substitution exerted a statistically significant effect on pruritus.

Table Graphic Jump LocationTable 5. Pooled Odds Ratios for Pruritus Associated With HES

In 1 study of patients receiving intensive care, 44% of the patients developing pruritus experienced a severe, persistent, and refractory form of the condition.95 Pruritus associated with HES was typically delayed in onset and manifested as pruritic crises,52,99,105 prompting patients to seek medical attention and seriously detracting from their quality of life.95 Pruritus associated with HES is generally unresponsive to currently available forms of therapy.52

COAGULOPATHY

Results of numerous studies indicate that HES administration can lead to reduction in circulating factor VIII and von Willebrand factor levels, impairment of platelet function, prolongation of partial thromboplastin time and activated partial thromboplastin time, and increase in bleeding complications.27,29,34,40,61,62,69,78,80,82,94,103,104 Coagulopathy and hemorrhage associated with HES are often encountered in cardiac surgery, a setting in which susceptibility to such complications is heightened by transient acquired platelet dysfunction resulting from the procedure. Thus, in cardiac surgery studies with albumin as the control, HES has resulted in platelet depletion and dysfunction, prothrombin time and activated partial thromboplastin time prolongation, and increased postoperative bleeding.3,11,13,15,17,46,48,50,65,92 One NCT of 444 patients revealed significant increases in blood product use, as well as postoperative blood loss, in patients receiving HES for volume expansion.98 The effects of HES on clinical bleeding in cardiac surgery patients depend on dose; however, excessive postoperative bleeding has been reported with HES doses less than the recommended maximum.87

Results of 1 RCT suggested that postoperative bleeding might be greater in patients receiving HES of high rather than medium molecular weight.50 This result was not supported, however, by results of 1 NCT of 200 patients showing postoperative blood loss significantly greater after pump priming with HES of medium molecular weight than with albumin.92 Furthermore, in 1 MA of RCTs, bleeding was increased by HES, as compared with albumin, and the effects of HES of high and medium molecular weight were similar.109

Dextran, as compared with albumin, has been shown to reduce platelets and increase postoperative bleeding in cardiac surgery patients.56 Postoperative blood loss was linearly correlated with the volume of gelatin used to prime the extracorporeal circuit.60

RENAL FAILURE

All 3 artificial colloids have been associated with renal impairment, and HES has been demonstrated to increase sensitive markers of renal tubule damage in surgical patients.74,93 In 1 RCT of sepsis patients, HES exposure was recently shown to be an independent risk factor for acute renal failure.108

In the renal transplantation setting, HES reduced urinary output, increased creatinine levels and dopamine requirement, and increased the need for hemodialysis or hemodiafiltration.64,66 By contrast, in 1 NCT, no significant difference was evident in delayed graft function after renal transplantation with administration of HES to the donor.89

In a cohort study of patients with acute ischemic stroke, 4.7% experienced acute renal failure associated with dextran infusion.72 Gelatin, as compared with albumin as pump prime in cardiac surgery, elevated creatinine levels.41

CIRCULATORY DYSFUNCTION

The occurrence of circulatory dysfunction marked by increased plasma renin activity and aldosterone has been investigated in patients who have ascites and are undergoing large-volume paracentesis. The incidence of circulatory dysfunction was significantly higher after infusion of dextran than of albumin in 2 RCTs38,67 but not in a third.47 Circulatory dysfunction was also more frequent in patients receiving gelatin than in those receiving albumin.67

HEPATIC DYSFUNCTION

Repeated infusion of HES in conjunction with dialysis resulted in the development of ascites that necessitated Denver shunt implantation in 1 case.18 In 1 recent study, HES deposition in hepatic Kupffer cells was associated with worsening of hepatic dysfunction after HES infusion.101 Pump priming with HES, as compared with albumin, during cardiac surgery has been found to increase levels of liver enzymes during and after cardiopulmonary bypass surgery.15

TISSUE DEPOSITION

Hydroxyethyl starch is deposited in a variety of tissues, including skin, liver, muscle, spleen, intestine, trophoblast, and placental stroma.18,40,55,96,101 Such deposition often has been described in association with pruritus.55,96 Tissue deposits persist as long as 54 months after HES administration.96 Organ deposition of dextran has been reported in 1 NCT of patients undergoing long-term hemodialysis.35 Tissue deposition of administered albumin has not been detected at necroscopic examination.5

The major conclusion emerging from this systematic review is that there are clinically important differences in safety among colloids. Many of the differences have been demonstrated between albumin and HES, possibly because these 2 colloids have been more extensively investigated than have dextran and gelatin.

The incidence of adverse events in albumin recipients was low. Albumin administration was not consistently associated with any characteristic types of adverse events. This observation is perhaps unsurprising, because albumin infusion serves to replenish the normal endogenous colloid. Although albumin is isolated from human plasma, we could identify no evidence of viral disease transmission attributable to albumin.

Bleeding associated with artificial colloid administration has been widely reported.3,21,27,40,49,50,56,60,62,73,87,92,98,104,109 Such complications have been particularly frequent in the cardiac surgery setting, necessitating increased blood product use and increased costs of care.87,98 Bleeding complications can be particularly troublesome because of the long half-life of HES and because discontinuation of HES infusion cannot immediately resolve coagulopathy.

Although potentially life threatening, anaphylactoid reactions were relatively infrequent for all colloids. Hydroxyethyl starch, as compared with albumin, more than quadrupled the incidence of anaphylactoid reactions, whereas dextran more than doubled them. The incidence of these reactions in recipients of gelatin was greater by more than an order of magnitude than that after albumin infusion. Because artificial colloids are derived from nonhuman source materials, they may be recognized as foreign and hence are more likely to provoke an immune-mediated response. The foreign nature of artificial colloids may also hinder metabolic clearance and promote tissue deposition.

Although HES has been widely used for several decades, HES-related pruritus has been widely described only since the early 1990s.45 Its late recognition as a clinical entity appears to be at least partly because of the lengthy delay in onset of symptoms, in many cases occurring after discharge. This adverse effect was initially characterized in otologic patients receiving relatively high HES doses to improve microcirculation. Besides otologic indications, we identified evidence of HES-associated pruritus in studies of general96 and cardiac99 surgery, patients receiving intensive care,95,106 and subarachnoid hemorrhage.105 In our MA, the pooled odds of pruritus were significantly increased by HES exposure. Although the effect was dose related, many patients receiving less than the recommended 20 mL/kg HES maximum were affected.95,99 In a cardiac surgery study, more than half of the patients developing pruritus had received less than the recommended HES maximum.99

We compiled substantial evidence linking HES exposure to increased risk of renal failure. This effect has been characterized in the settings of surgery,74,93 sepsis,108 and kidney transplantation.64,66 Adverse effects of HES in kidney transplantation have, however, been controversial.89

Outside the United States, HES products of varying molecular weight and/or molar substitution have been introduced. It has often been argued that adverse effects of HES are primarily attributable to preparations of higher molecular weight and greater molar substitution.61,70 The basis for such putative differences is the more rapid clearance of HES of lower molecular weight and less highly substituted forms. In our MA, neither HES molecular weight nor molar substitution significantly affected the odds of pruritus. More broadly, our systematic review failed to reveal consistent differences among HES preparations with respect to safety.

On the basis of extensive evidence, albumin appears to be in general the safest colloid of the 4 we reviewed. In some settings, other factors such as the desirability of anticoagulant activity might militate in favor of artificial colloids. In any case, results of our review suggest the need to consider the contrasting safety profiles of colloids in clinical decision making.

Corresponding author and reprints: Mahlon M. Wilkes, PhD, Hygeia Associates, 17988 Brewer Rd, Grass Valley, CA 95949, (e-mail: mwilkes@hygeiaassociates.com).

Accepted for publication August 13, 2003.

Prien  TBackhaus  NPelster  FPircher  WBünte  HLawin  P Effect of intraoperative fluid administration and colloid osmotic pressure on the formation of intestinal edema during gastrointestinal surgery. J Clin Anesth. 1990;2317- 323
PubMed Link to Article
Ring  JMessmer  K Incidence and severity of anaphylactoid reactions to colloid volume substitutes. Lancet. 1977;1466- 469
PubMed Link to Article
Mastroianni  LLow  HBRollman  JWagle  MBleske  BChow  MS A comparison of 10% pentastarch and 5% albumin in patients undergoing open-heart surgery. J Clin Pharmacol. 1994;3434- 40
PubMed Link to Article
London  MJHo  JSTriedman  JK  et al.  A randomized clinical trial of 10% pentastarch (low molecular weight hydroxyethyl starch) versus 5% albumin for plasma volume expansion after cardiac operations. J Thorac Cardiovasc Surg. 1989;97785- 797
PubMed
Janeway  CAGibson  STWoodruff  LMHeyl  JTBailey  OTNewhouser  LR Chemical, clinical, and immunological studies on the products of human plasma fractionation, VII: concentrated human serum albumin. J Clin Invest. 1944;23465- 490
Link to Article
Lundsgaard-Hansen  PTschirren  B Clinical experience with 120,000 units of modified fluid gelatin. Dev Biol Stand. 1980;48251- 256
PubMed
Quast  UWelge-Lüssen  USedlacek  HH Adverse reactions in connection with albumin and other plasma substitutes. Dev Biol Stand. 1980;48131- 142
PubMed
Schöning  BLorenz  W Prevention of allergoid (cutaneous anaphylactoid) reactions to polygeline (Haemaccel) in orthopaedic patients by premedication with H1- and H2-receptor antagonists. Dev Biol Stand. 1980;48241- 249
PubMed
Diehl  JTLester  JLCosgrove  DM Clinical comparison of hetastarch and albumin in postoperative cardiac patients. Ann Thorac Surg. 1982;34674- 679
PubMed Link to Article
Kassell  NFPeerless  SJDurward  QJBeck  DWDrake  CGAdams  HP Treatment of ischemic deficits from vasospasm with intravascular volume expansion and induced arterial hypertension. Neurosurgery. 1982;11337- 343
PubMed Link to Article
Palanzo  DAParr  GVBull  APWilliams  DRO'Neill  MJWaldhausen  JA Hetastarch as a prime for cardiopulmonary bypass. Ann Thorac Surg. 1982;34680- 683
PubMed Link to Article
Blanloeil  YGunst  JPSpreux  ACozian  ADixneuf  B Accidents anaphylactoïdes sévères après perfusion d'une gélatine fluide modifiée en solution équilibrée: deux études prospectives. Therapie. 1983;38539- 546
PubMed
Moggio  RARha  CCSomberg  EDPraeger  PIPooley  RWReed  GE Hemodynamic comparison of albumin and hydroxyethyl starch in postoperative cardiac surgery patients. Crit Care Med. 1983;11943- 945
PubMed Link to Article
Rackow  ECFalk  JLFein  IA  et al.  Fluid resuscitation in circulatory shock: a comparison of the cardiorespiratory effects of albumin, hetastarch, and saline solutions in patients with hypovolemic and septic shock. Crit Care Med. 1983;11839- 850
PubMed Link to Article
Saunders  CRCarlisle  LBick  RL Hydroxyethyl starch versus albumin in cardiopulmonary bypass prime solutions. Ann Thorac Surg. 1983;36532- 539
PubMed Link to Article
Weis  KH Haemaccel 35: Nebenreaktionen in einer multizentrischen, prospektiven Studie. Anaesthesist. 1983;32488- 493
PubMed
Kirklin  JKLell  WAKouchoukos  NT Hydroxyethyl starch versus albumin for colloid infusion following cardiopulmonary bypass in patients undergoing myocardial revascularization. Ann Thorac Surg. 1984;3740- 46
PubMed Link to Article
Pfeifer  UKult  JForster  H Ascites als Komplikation hepatischer Speicherung von Hydroxyethylstärke (HES) bei Langzeitdialyse. Klin Wochenschr. 1984;62862- 866
PubMed Link to Article
Schöning  BSommer  KKoch  H Herzstillstand unter Dextraninfusion trotz Haptenhemmung. Anasth Intensivther Notfallmed. 1984;1934- 38
PubMed Link to Article
Gallagher  JDMoore  RAKerns  D  et al.  Effects of colloid or crystalloid administration on pulmonary extravascular water in the postoperative period after coronary artery bypass grafting. Anesth Analg. 1985;64753- 758
PubMed
Harris  WHAthanasoulis  CAWaltman  ACSalzman  EW Prophylaxis of deep-vein thrombosis after total hip replacement: dextran and external pneumatic compression compared with 1.2 or 0.3 gram of aspirin daily. J Bone Joint Surg Am. 1985;6757- 62
PubMed
Sade  RMStroud  MRCrawford  FAKratz  JMDearing  JPBartles  DM A prospective randomized study of hydroxyethyl starch, albumin, and lactated Ringer's solution as priming fluid for cardiopulmonary bypass. J Thorac Cardiovasc Surg. 1985;89713- 722
PubMed
Boldt  Jvon Bormann  BKling  DBorner  UMulch  JHempelmann  G Volumenersatz mit einem neuen Hydroxyäthylstärke-Präparat (3% HÄS 200/0,5) in der Herzchirurgie. Infusionsther Klin Ernahr. 1986;13145- 151
PubMed
Dawidson  IBerglin  EBrynger  HReisch  J Intravascular volumes and colloid dynamics in relation to fluid management in living related kidney donors and recipients. Crit Care Med. 1987;15631- 636
PubMed Link to Article
Lumb  PD A comparison between 25% albumin and 6% hydroxyethyl starch solutions on lung water accumulation during and immediately after cardiopulmonary bypass. Ann Surg. 1987;206210- 213
PubMed Link to Article
Paull  J A prospective study of dextran-induced anaphylactoid reactions in 5745 patients. Anaesth Intensive Care. 1987;15163- 167
PubMed
Iacono  RPLinford  JToole  JG Use of hetastarch for volume expansion [letter]. J Neurosurg. 1987;66635- 637
PubMed
Turner  PJYoung  IFMarley  PBHerrington  RWSchiff  P Albumin solutions: their production and quality control. Dev Biol Stand. 1987;67119- 127
PubMed
Falk  JLRackow  ECAstiz  MEWeil  MH Effects of hetastarch and albumin on coagulation in patients with septic shock. J Clin Pharmacol. 1988;28412- 415
PubMed Link to Article
Fujii  H Plasma exchange using dextran 40-electrolyte solution as the sole replacement fluid in malignant paraproteinemia. Transfusion. 1988;2842- 45
PubMed Link to Article
Köppel  CBaudisch  HIbe  K Inadvertent metal loading of critically ill patients with acute renal failure by human albumin solution infusion therapy. J Toxicol Clin Toxicol. 1988;26337- 356
PubMed
Hemodilution in Stroke Study Group, Hypervolemic hemodilution treatment of acute stroke: results of a randomized multicenter trial using pentastarch. Stroke. 1989;20317- 323
PubMed Link to Article
Mercatello  ALaville  MLeizorovicz  A Effets indésirables des échanges plasmatiques thérapeutiques: étude prospective contrôlée. Presse Med. 1989;18325- 329
PubMed
Rackow  ECMecher  CAstiz  MEGriffel  MFalk  JLWeil  MH Effects of pentastarch and albumin infusion on cardiorespiratory function and coagulation in patients with severe sepsis and systemic hypoperfusion. Crit Care Med. 1989;17394- 398
PubMed Link to Article
Bergonzi  GPaties  CVassallo  G  et al.  Dextran deposits in tissues of patients undergoing haemodialysis. Nephrol Dial Transplant. 1990;554- 58
PubMed Link to Article
Gold  MSRusso  JTissot  MWeinhouse  GRiles  T Comparison of hetastarch to albumin for perioperative bleeding in patients undergoing abdominal aortic aneurysm surgery: a prospective, randomized study. Ann Surg. 1990;211482- 485
PubMed Link to Article
Levy  IMerlob  PAshkenazi  SReisner  SH Neonatal polycythaemia: effect of partial dilutional exchange transfusion with human albumin on whole blood viscosity. Eur J Pediatr. 1990;149354- 355
PubMed Link to Article
Planas  RGinès  PArroyo  V  et al.  Dextran-70 versus albumin as plasma expanders in cirrhotic patients with tense ascites treated with total paracentesis: results of a randomized study. Gastroenterology. 1990;991736- 1744
PubMed
Heilmann  LHeitz  RKoch  FUOse  C Die perioperative Thromboseprophylaxe beim Kaiserschnitt: Ergebnisse einer randomisierten prospektiven Vergleichsuntersuchung mit 6% Hydroxyäthylstärke 0,62 und low-dose-Heparin. Z Geburtshilfe Perinatol. 1991;19510- 15
PubMed
Heilmann  LLorch  EHojnacki  BMüntefering  HFörster  H Die Speicherung von zwei unterschiedlichen Hydroxyäthylstärke-Präparaten in der Plazenta nach Hämodilution bei Patientinnen mit fetaler Mangelentwicklung oder Schwangerschaftshochdruck. Infusionstherapie. 1991;18236- 243
PubMed
Himpe  DVan Cauwelaert  PNeels  H  et al.  Priming solutions for cardiopulmonary bypass: comparison of three colloids. J Cardiothorac Vasc Anesth. 1991;5457- 466
PubMed Link to Article
Kaniecki  KBiesel  EZielke  E Untersuchungen zur Verträglighkeit von Haemofusin in der Hämodilution und Volumensubstitution. Infusionstherapie. 1991;18306- 309
PubMed
Mast  HMarx  P Neurological deterioration under isovolemic hemodilution with hydroxyethyl starch in acute cerebral ischemia. Stroke. 1991;22680- 683
PubMed Link to Article
Salerno  FBadalamenti  SLorenzano  EMoser  PIncerti  P Randomized comparative study of hemaccel vs albumin infusion after total paracentesis in cirrhotic patients with refractory ascites. Hepatology. 1991;13707- 713
PubMed Link to Article
Albegger  KSchneeberger  RFranke  VOberascher  GMiller  K Juckreiz nach Therapie mit Hydroxyäthylstärke (HES) bei otoneurologischen Erkrankungen. Wien Med Wochenschr. 1992;1421- 7
PubMed
Boldt  JZickmann  BBallesteros  BMStertmann  FHempelmann  G Influence of five different priming solutions on platelet function in patients undergoing cardiac surgery. Anesth Analg. 1992;74219- 225
PubMed Link to Article
Fassio  ETerg  RLandeira  G  et al.  Paracentesis with Dextran 70 vs paracentesis with albumin in cirrhosis with tense ascites: results of a randomized study. J Hepatol. 1992;14310- 316
PubMed Link to Article
London  MJFranks  MVerrier  EDMerrick  SHLevin  JMangano  DT The safety and efficacy of ten percent pentastarch as a cardiopulmonary bypass priming solution: a randomized clinical trial. J Thorac Cardiovasc Surg. 1992;104284- 296
PubMed
Villarino  MEGordon  SMValdon  C  et al.  A cluster of severe postoperative bleeding following open heart surgery. Infect Control Hosp Epidemiol. 1992;13282- 287
PubMed Link to Article
Boldt  JKnothe  CZickmann  BAndres  PDapper  FHempelmann  G Influence of different intravascular volume therapies on platelet function in patients undergoing cardiopulmonary bypass. Anesth Analg. 1993;761185- 1190
PubMed Link to Article
Boldt  JKnothe  CSchindler  EHammermann  HDapper  FHempelmann  G Volume replacement with hydroxyethyl starch solution in children. Br J Anaesth. 1993;70661- 665
PubMed Link to Article
Gall  HKaufmann  Rvon  Ehr MSchumann  KSterry  W Persistierender Pruritus nach Hydroxyäthylstärke-Infusionen: retrospektive Langzeitstudie an 266 Fällen. Hautarzt. 1993;44713- 716
PubMed
Grundmann  TGramer  L Pruritus bei Infusionstherapie mit Hydroxyethylstärke verschiedener Menge. Wehrmed Monatsschr. 1993;247- 48
Haws  RMBaum  M Efficacy of albumin and diuretic therapy in children with nephrotic syndrome. Pediatrics. 1993;911142- 1146
PubMed
Jurecka  WSzepfalusi  ZParth  E  et al.  Hydroxyethylstarch deposits in human skin: a model for pruritus? Arch Dermatol Res. 1993;28513- 19
PubMed Link to Article
Videm  VFosse  ESvennevig  JL Platelet preservation during coronary bypass surgery with bubble and membrane oxygenators: effect of albumin priming. Perfusion. 1993;8409- 415
Link to Article
Laxenaire  MCCharpentier  CFeldman  L Réaction anaphylactoïdes aux substituts colloïdaux du plasma: incidence, facteurs de risque, mécanismses: enquête prospective multicentrique française. Ann Fr Anesth Reanim. 1994;13301- 310
PubMed Link to Article
Desloovere  CKnecht  R Infusionstherapie bei Hörsturz: Reduktion des Juckreizrisikos nach Hydroxyethylstärke (HES) unter Erhalt des Therapieerfolges: eine prospektive randomisierte Studie. Laryngorhinootologie. 1995;74468- 472
PubMed Link to Article
Leunig  ASzeimies  RMWilmes  EGutmann  RStolz  WFeyh  J Klinische und elektronenmikroskopische Untersuchung zur Hörsturztherapie mit der Kombination 10% HES 200/0.5 und Pentoxifyllin. Laryngorhinootologie. 1995;74135- 140
PubMed Link to Article
Tabuchi  Nde  Haan JGallandat  Huet RCBoonstra  PWvan  Oeveren W Gelatin use impairs platelet adhesion during cardiac surgery. Thromb Haemost. 1995;741447- 1451
PubMed
Treib  JHaass  APindur  G  et al.  HES 200/0.5 is not HES 200/0.5: influence of the C2/C6 hydroxyethylation ratio of hydroxyethyl starch (HES) on hemorheology, coagulation and elimination kinetics. Thromb Haemost. 1995;741452- 1456
PubMed
Trumble  ERMuizelaar  JPMyseros  JSChoi  SCWarren  BB Coagulopathy with the use of hetastarch in the treatment of vasospasm. J Neurosurg. 1995;8244- 47
PubMed Link to Article
Tølløfsrud  SSvennevig  JLBreivik  H  et al.  Fluid balance and pulmonary functions during and after coronary artery bypass surgery: Ringer's acetate compared with dextran, polygeline, or albumin. Acta Anaesthesiol Scand. 1995;39671- 677
PubMed Link to Article
Bernard  CAlain  MSimone  CXavier  MJean-Francois  M Hydroxyethylstarch and osmotic nephrosis-like lesions in kidney transplants [letter]. Lancet. 1996;3481595
PubMed Link to Article
Brutocao  DBratton  SLThomas  JRSchrader  PFColes  PGLynn  AM Comparison of hetastarch with albumin for postoperative volume expansion in children after cardiopulmonary bypass. J Cardiothorac Vasc Anesth. 1996;10348- 351
PubMed Link to Article
Cittanova  MLLeblanc  ILegendre  CMouquet  CRiou  BCoriat  P Effect of hydroxyethylstarch in brain-dead kidney donors on renal function in kidney-transplant recipients. Lancet. 1996;3481620- 1622
PubMed Link to Article
Ginès  AFernández-Esparrach  GMonescillo  A  et al.  Randomized trial comparing albumin, dextran 70, and polygeline in cirrhotic patients with ascites treated by paracentesis. Gastroenterology. 1996;1111002- 1010
PubMed Link to Article
Schneider  MValentine  SClarke  GMNewman  MAPeacock  J Acute renal failure in cardiac surgical patients, potentiated by gentamicin and calcium. Anaesth Intensive Care. 1996;24647- 650
PubMed
Treib  JHaass  APindur  G  et al.  Influence of low and medium molecular weight hydroxyethyl starch on platelets during a long-term hemodilution in patients with cerebrovascular diseases. Arzneimittelforschung. 1996;461064- 1066
PubMed
Treib  JHaass  APindur  GTreib  WWenzel  ESchimrigk  K Influence of intravascular molecular weight of hydroxyethyl starch on platelets. Eur J Haematol. 1996;56168- 172
PubMed Link to Article
Wahba  ASendtner  EBirnbaum  DE Fluid resuscitation with Haemaccel vs human albumin following coronary artery bypass grafting. Thorac Cardiovasc Surg. 1996;44178- 182
PubMed Link to Article
Biesenbach  GKaiser  WZazgornik  J Incidence of acute oligoanuric renal failure in dextran 40 treated patients with acute ischemic stroke stage III or IV. Ren Fail. 1997;1969- 75
PubMed Link to Article
Cope  JTBanks  DMauney  MC  et al.  Intraoperative hetastarch infusion impairs hemostasis after cardiac operations. Ann Thorac Surg. 1997;6378- 82
PubMed Link to Article
Dehne  MGMühling  JSablotzki  APapke  GKuntzsch  UHempelmann  G Einfluß von Hydroxyethylstärke-Lösung auf die Nierenfunktion bei operativen Intensivpatienten. Anasthesiol Intensivmed Notfallmed Schmerzther. 1997;32348- 354
PubMed Link to Article
Hedin  HLjungström  KG Prevention of dextran anaphylaxis: ten years experience with hapten dextran. Int Arch Allergy Immunol. 1997;113358- 359
PubMed Link to Article
Metze  DReimann  SSzepfalusi  ZBohle  BKraft  DLuger  TA Persistent pruritus after hydroxyethyl starch infusion therapy: a result of long-term storage in cutaneous nerves. Br J Dermatol. 1997;136553- 559
PubMed Link to Article
Owen  HGBrecher  ME Partial colloid starch replacement for therapeutic plasma exchange. J Clin Apheresis. 1997;1287- 92
PubMed Link to Article
Rock  GSutton  DMFreedman  JNair  RC Pentastarch instead of albumin as replacement fluid for therapeutic plasma exchange: the Canadian Apheresis Group. J Clin Apheresis. 1997;12165- 169
PubMed Link to Article
Saxena  NChauhan  SRamesh  GS A comparison of hetastarch, albumin and Ringer lactate for volume replacement in coronary artery bypass surgery. J Anaesth Clin Pharm. 1997;13117- 120
Stoll  MTreib  JSchenk  JF  et al.  No coagulation disorders under high-dose volume therapy with low-molecular-weight hydroxyethyl starch. Haemostasis. 1997;27251- 258
PubMed
Tigchelaar  IGallandat  Huet RCKorsten  JBoonstra  PWvan  Oeveren W Hemostatic effects of three colloid plasma substitutes for priming solution in cardiopulmonary bypass. Eur J Cardiothorac Surg. 1997;11626- 632
PubMed Link to Article
Treib  JHaass  APindur  G  et al.  Increased haemorrhagic risk after repeated infusion of highly substituted medium molecular weight hydroxyethyl starch. Arzneimittelforschung. 1997;4718- 22
PubMed
Altman  CBernard  BRoulot  DVitte  RLInk  O Randomized comparative multicenter study of hydroxyethyl starch versus albumin as a plasma expander in cirrhotic patients with tense ascites treated with paracentesis. Eur J Gastroenterol Hepatol. 1998;105- 10
PubMed Link to Article
Bothner  UGeorgieff  MVogt  NH Assessment of the safety and tolerance of 6% hydroxyethyl starch (200/0.5) solution: a randomized, controlled epidemiology study. Anesth Analg. 1998;86850- 855
PubMed
Cochrane Injuries Group Albumin Reviewers, Human albumin administration in critically ill patients: systematic review of randomised controlled trials. BMJ. 1998;317235- 240
PubMed Link to Article
Gröchenig  EAlbegger  KDieterich  HJ  et al.  Hydroxyethylstarch-related pruritus: a prospective multicentre investigation of 544 patients. Perfusion. 1998;1162- 69
Herwaldt  LASwartzendruber  SKEdmond  MB  et al.  The epidemiology of hemorrhage related to cardiothoracic operations. Infect Control Hosp Epidemiol. 1998;199- 16
PubMed Link to Article
Tigchelaar  IGallandat  Huet RCBoonstra  PWvan  Oeveren W Comparison of three plasma expanders used as priming fluids in cardiopulmonary bypass patients. Perfusion. 1998;13297- 303
PubMed Link to Article
Deman  APeeters  PSennesael  J Hydroxyethyl starch does not impair immediate renal function in kidney transplant recipients: a retrospective, multicentre analysis. Nephrol Dial Transplant. 1999;141517- 1520
PubMed Link to Article
Goss  GAWeinstein  R Pentastarch as partial replacement fluid for therapeutic plasma exchange: effect on plasma proteins, adverse events during treatment, and serum ionized calcium. J Clin Apheresis. 1999;14114- 121
PubMed Link to Article
Karoutsos  SNathan  NLahrimi  AGrouille  DFeiss  PCox  DJ Thrombelastogram reveals hypercoagulability after administration of gelatin solution. Br J Anaesth. 1999;82175- 177
PubMed Link to Article
Keyser  EJLatter  DAMorin  JEMurshid  AADenis  Fde Varennes  B Pentastarch versus albumin in cardiopulmonary bypass prime: impact on blood loss. J Card Surg. 1999;14279- 286
PubMed Link to Article
Kumle  BBoldt  JPiper  SSchmidt  CSuttner  SSalopek  S The influence of different intravascular volume replacement regimens on renal function in the elderly. Anesth Analg. 1999;891124- 1130
PubMed Link to Article
Omar  MNShouk  TAKhaleq  MA Activity of blood coagulation and fibrinolysis during and after hydroxyethyl starch (HES) colloidal volume replacement. Clin Biochem. 1999;32269- 274
PubMed Link to Article
Sharland  CHuggett  ANielson  MSFriedmann  PS Persistent pruritis after pentastarch infusions in intensive care patients. Anaesthesia. 1999;54500- 501
PubMed Link to Article
Sirtl  CLaubenthal  HZumtobel  VKraft  DJurecka  W Tissue deposits of hydroxyethyl starch (HES): dose-dependent and time-related. Br J Anaesth. 1999;82510- 515
PubMed Link to Article
Canver  CCNichols  RD Use of intraoperative hetastarch priming during coronary bypass. Chest. 2000;1181616- 1620
PubMed Link to Article
Knutson  JEDeering  JAHall  FW  et al.  Does intraoperative hetastarch administration increase blood loss and transfusion requirements after cardiac surgery? Anesth Analg. 2000;90801- 807
PubMed Link to Article
Morgan  PWBerridge  JC Giving long-persistent starch as volume replacement can cause pruritus after cardiac surgery. Br J Anaesth. 2000;85696- 699
PubMed Link to Article
Torchia  MGDanzinger  RG Perioperative blood transfusion and albumin administration are independent risk factors for the development of postoperative infections after colorectal surgery. Can J Surg. 2000;43212- 216
PubMed
Christidis  CMal  FRamos  J  et al.  Worsening of hepatic dysfunction as a consequence of repeated hydroxyethylstarch infusions. J Hepatol. 2001;35726- 732
PubMed Link to Article
Howard  GDownward  GBowie  D Human serum albumin induced hypotension in the postoperative phase of cardiac surgery. Anaesth Intensive Care. 2001;29591- 594
PubMed
Huraux  CAnkri  AAEyraud  D  et al.  Hemostatic changes in patients receiving hydroxyethyl starch: the influence of ABO blood group. Anesth Analg. 2001;921396- 1401
PubMed Link to Article
Jonville-Béra  APAutret-Leca  EGruel  Y Acquired type I von Willebrand's disease associated with highly substituted hydroxyethyl starch. N Engl J Med. 2001;345622- 623
PubMed Link to Article
Kimme  PJannsen  BLedin  TGupta  AVegfors  M High incidence of pruritus after large doses of hydroxyethyl starch (HES) infusions. Acta Anaesthesiol Scand. 2001;45686- 689
PubMed Link to Article
Murphy  MCarmichael  AJLawler  PGWhite  MCox  NH The incidence of hydroxyethyl starch-associated pruritus. Br J Dermatol. 2001;144973- 976
PubMed Link to Article
Petroni  KCGreen  RBirmingham  S Hextend is a safe alternative to 5% human albumin for patients undergoing elective cardiac surgery [abstract]. Anesthesiology. 2001;95A198
Schortgen  FLacherade  JCBruneel  F  et al.  Effects of hydroxyethylstarch and gelatin on renal function in severe sepsis: a multicentre randomised study. Lancet. 2001;357911- 916
PubMed Link to Article
Wilkes  MMNavickis  RJSibbald  WJ Albumin versus hydroxyethyl starch in cardiopulmonary bypass surgery: a meta-analysis of postoperative bleeding. Ann Thorac Surg. 2001;72527- 534
PubMed Link to Article
Wilkes  MMNavickis  RJ Patient survival after human albumin administration: a meta-analysis of randomized, controlled trials. Ann Intern Med. 2001;135149- 164
PubMed Link to Article
von Hoegen  IWaller  C Safety of human albumin based on spontaneously reported serious adverse events. Crit Care Med. 2001;29994- 996
PubMed Link to Article
Kuo  STHsu  WCYoung  YH Dextran-induced pulmonary edema in patients with sudden deafness. Otol Neurotol. 2002;23661- 664
PubMed Link to Article
Trull  AHughes  VCooper  D  et al.  Influence of albumin supplementation on tacrolimus and cyclosporine therapy early after liver transplantation. Liver Transpl. 2002;8224- 232
PubMed Link to Article
Lucas  CEWeaver  DHiggins  RFLedgerwood  AMJohnson  SDBouwman  DL Effects of albumin versus non-albumin resuscitation on plasma volume and renal excretory function. J Trauma. 1978;18564- 570
PubMed Link to Article

Figures

Tables

Table Graphic Jump LocationTable 4. Pooled Incidence Rate Ratios for Anaphylactoid Reactions
Table Graphic Jump LocationTable 5. Pooled Odds Ratios for Pruritus Associated With HES

References

Prien  TBackhaus  NPelster  FPircher  WBünte  HLawin  P Effect of intraoperative fluid administration and colloid osmotic pressure on the formation of intestinal edema during gastrointestinal surgery. J Clin Anesth. 1990;2317- 323
PubMed Link to Article
Ring  JMessmer  K Incidence and severity of anaphylactoid reactions to colloid volume substitutes. Lancet. 1977;1466- 469
PubMed Link to Article
Mastroianni  LLow  HBRollman  JWagle  MBleske  BChow  MS A comparison of 10% pentastarch and 5% albumin in patients undergoing open-heart surgery. J Clin Pharmacol. 1994;3434- 40
PubMed Link to Article
London  MJHo  JSTriedman  JK  et al.  A randomized clinical trial of 10% pentastarch (low molecular weight hydroxyethyl starch) versus 5% albumin for plasma volume expansion after cardiac operations. J Thorac Cardiovasc Surg. 1989;97785- 797
PubMed
Janeway  CAGibson  STWoodruff  LMHeyl  JTBailey  OTNewhouser  LR Chemical, clinical, and immunological studies on the products of human plasma fractionation, VII: concentrated human serum albumin. J Clin Invest. 1944;23465- 490
Link to Article
Lundsgaard-Hansen  PTschirren  B Clinical experience with 120,000 units of modified fluid gelatin. Dev Biol Stand. 1980;48251- 256
PubMed
Quast  UWelge-Lüssen  USedlacek  HH Adverse reactions in connection with albumin and other plasma substitutes. Dev Biol Stand. 1980;48131- 142
PubMed
Schöning  BLorenz  W Prevention of allergoid (cutaneous anaphylactoid) reactions to polygeline (Haemaccel) in orthopaedic patients by premedication with H1- and H2-receptor antagonists. Dev Biol Stand. 1980;48241- 249
PubMed
Diehl  JTLester  JLCosgrove  DM Clinical comparison of hetastarch and albumin in postoperative cardiac patients. Ann Thorac Surg. 1982;34674- 679
PubMed Link to Article
Kassell  NFPeerless  SJDurward  QJBeck  DWDrake  CGAdams  HP Treatment of ischemic deficits from vasospasm with intravascular volume expansion and induced arterial hypertension. Neurosurgery. 1982;11337- 343
PubMed Link to Article
Palanzo  DAParr  GVBull  APWilliams  DRO'Neill  MJWaldhausen  JA Hetastarch as a prime for cardiopulmonary bypass. Ann Thorac Surg. 1982;34680- 683
PubMed Link to Article
Blanloeil  YGunst  JPSpreux  ACozian  ADixneuf  B Accidents anaphylactoïdes sévères après perfusion d'une gélatine fluide modifiée en solution équilibrée: deux études prospectives. Therapie. 1983;38539- 546
PubMed
Moggio  RARha  CCSomberg  EDPraeger  PIPooley  RWReed  GE Hemodynamic comparison of albumin and hydroxyethyl starch in postoperative cardiac surgery patients. Crit Care Med. 1983;11943- 945
PubMed Link to Article
Rackow  ECFalk  JLFein  IA  et al.  Fluid resuscitation in circulatory shock: a comparison of the cardiorespiratory effects of albumin, hetastarch, and saline solutions in patients with hypovolemic and septic shock. Crit Care Med. 1983;11839- 850
PubMed Link to Article
Saunders  CRCarlisle  LBick  RL Hydroxyethyl starch versus albumin in cardiopulmonary bypass prime solutions. Ann Thorac Surg. 1983;36532- 539
PubMed Link to Article
Weis  KH Haemaccel 35: Nebenreaktionen in einer multizentrischen, prospektiven Studie. Anaesthesist. 1983;32488- 493
PubMed
Kirklin  JKLell  WAKouchoukos  NT Hydroxyethyl starch versus albumin for colloid infusion following cardiopulmonary bypass in patients undergoing myocardial revascularization. Ann Thorac Surg. 1984;3740- 46
PubMed Link to Article
Pfeifer  UKult  JForster  H Ascites als Komplikation hepatischer Speicherung von Hydroxyethylstärke (HES) bei Langzeitdialyse. Klin Wochenschr. 1984;62862- 866
PubMed Link to Article
Schöning  BSommer  KKoch  H Herzstillstand unter Dextraninfusion trotz Haptenhemmung. Anasth Intensivther Notfallmed. 1984;1934- 38
PubMed Link to Article
Gallagher  JDMoore  RAKerns  D  et al.  Effects of colloid or crystalloid administration on pulmonary extravascular water in the postoperative period after coronary artery bypass grafting. Anesth Analg. 1985;64753- 758
PubMed
Harris  WHAthanasoulis  CAWaltman  ACSalzman  EW Prophylaxis of deep-vein thrombosis after total hip replacement: dextran and external pneumatic compression compared with 1.2 or 0.3 gram of aspirin daily. J Bone Joint Surg Am. 1985;6757- 62
PubMed
Sade  RMStroud  MRCrawford  FAKratz  JMDearing  JPBartles  DM A prospective randomized study of hydroxyethyl starch, albumin, and lactated Ringer's solution as priming fluid for cardiopulmonary bypass. J Thorac Cardiovasc Surg. 1985;89713- 722
PubMed
Boldt  Jvon Bormann  BKling  DBorner  UMulch  JHempelmann  G Volumenersatz mit einem neuen Hydroxyäthylstärke-Präparat (3% HÄS 200/0,5) in der Herzchirurgie. Infusionsther Klin Ernahr. 1986;13145- 151
PubMed
Dawidson  IBerglin  EBrynger  HReisch  J Intravascular volumes and colloid dynamics in relation to fluid management in living related kidney donors and recipients. Crit Care Med. 1987;15631- 636
PubMed Link to Article
Lumb  PD A comparison between 25% albumin and 6% hydroxyethyl starch solutions on lung water accumulation during and immediately after cardiopulmonary bypass. Ann Surg. 1987;206210- 213
PubMed Link to Article
Paull  J A prospective study of dextran-induced anaphylactoid reactions in 5745 patients. Anaesth Intensive Care. 1987;15163- 167
PubMed
Iacono  RPLinford  JToole  JG Use of hetastarch for volume expansion [letter]. J Neurosurg. 1987;66635- 637
PubMed
Turner  PJYoung  IFMarley  PBHerrington  RWSchiff  P Albumin solutions: their production and quality control. Dev Biol Stand. 1987;67119- 127
PubMed
Falk  JLRackow  ECAstiz  MEWeil  MH Effects of hetastarch and albumin on coagulation in patients with septic shock. J Clin Pharmacol. 1988;28412- 415
PubMed Link to Article
Fujii  H Plasma exchange using dextran 40-electrolyte solution as the sole replacement fluid in malignant paraproteinemia. Transfusion. 1988;2842- 45
PubMed Link to Article
Köppel  CBaudisch  HIbe  K Inadvertent metal loading of critically ill patients with acute renal failure by human albumin solution infusion therapy. J Toxicol Clin Toxicol. 1988;26337- 356
PubMed
Hemodilution in Stroke Study Group, Hypervolemic hemodilution treatment of acute stroke: results of a randomized multicenter trial using pentastarch. Stroke. 1989;20317- 323
PubMed Link to Article
Mercatello  ALaville  MLeizorovicz  A Effets indésirables des échanges plasmatiques thérapeutiques: étude prospective contrôlée. Presse Med. 1989;18325- 329
PubMed
Rackow  ECMecher  CAstiz  MEGriffel  MFalk  JLWeil  MH Effects of pentastarch and albumin infusion on cardiorespiratory function and coagulation in patients with severe sepsis and systemic hypoperfusion. Crit Care Med. 1989;17394- 398
PubMed Link to Article
Bergonzi  GPaties  CVassallo  G  et al.  Dextran deposits in tissues of patients undergoing haemodialysis. Nephrol Dial Transplant. 1990;554- 58
PubMed Link to Article
Gold  MSRusso  JTissot  MWeinhouse  GRiles  T Comparison of hetastarch to albumin for perioperative bleeding in patients undergoing abdominal aortic aneurysm surgery: a prospective, randomized study. Ann Surg. 1990;211482- 485
PubMed Link to Article
Levy  IMerlob  PAshkenazi  SReisner  SH Neonatal polycythaemia: effect of partial dilutional exchange transfusion with human albumin on whole blood viscosity. Eur J Pediatr. 1990;149354- 355
PubMed Link to Article
Planas  RGinès  PArroyo  V  et al.  Dextran-70 versus albumin as plasma expanders in cirrhotic patients with tense ascites treated with total paracentesis: results of a randomized study. Gastroenterology. 1990;991736- 1744
PubMed
Heilmann  LHeitz  RKoch  FUOse  C Die perioperative Thromboseprophylaxe beim Kaiserschnitt: Ergebnisse einer randomisierten prospektiven Vergleichsuntersuchung mit 6% Hydroxyäthylstärke 0,62 und low-dose-Heparin. Z Geburtshilfe Perinatol. 1991;19510- 15
PubMed
Heilmann  LLorch  EHojnacki  BMüntefering  HFörster  H Die Speicherung von zwei unterschiedlichen Hydroxyäthylstärke-Präparaten in der Plazenta nach Hämodilution bei Patientinnen mit fetaler Mangelentwicklung oder Schwangerschaftshochdruck. Infusionstherapie. 1991;18236- 243
PubMed
Himpe  DVan Cauwelaert  PNeels  H  et al.  Priming solutions for cardiopulmonary bypass: comparison of three colloids. J Cardiothorac Vasc Anesth. 1991;5457- 466
PubMed Link to Article
Kaniecki  KBiesel  EZielke  E Untersuchungen zur Verträglighkeit von Haemofusin in der Hämodilution und Volumensubstitution. Infusionstherapie. 1991;18306- 309
PubMed
Mast  HMarx  P Neurological deterioration under isovolemic hemodilution with hydroxyethyl starch in acute cerebral ischemia. Stroke. 1991;22680- 683
PubMed Link to Article
Salerno  FBadalamenti  SLorenzano  EMoser  PIncerti  P Randomized comparative study of hemaccel vs albumin infusion after total paracentesis in cirrhotic patients with refractory ascites. Hepatology. 1991;13707- 713
PubMed Link to Article
Albegger  KSchneeberger  RFranke  VOberascher  GMiller  K Juckreiz nach Therapie mit Hydroxyäthylstärke (HES) bei otoneurologischen Erkrankungen. Wien Med Wochenschr. 1992;1421- 7
PubMed
Boldt  JZickmann  BBallesteros  BMStertmann  FHempelmann  G Influence of five different priming solutions on platelet function in patients undergoing cardiac surgery. Anesth Analg. 1992;74219- 225
PubMed Link to Article
Fassio  ETerg  RLandeira  G  et al.  Paracentesis with Dextran 70 vs paracentesis with albumin in cirrhosis with tense ascites: results of a randomized study. J Hepatol. 1992;14310- 316
PubMed Link to Article
London  MJFranks  MVerrier  EDMerrick  SHLevin  JMangano  DT The safety and efficacy of ten percent pentastarch as a cardiopulmonary bypass priming solution: a randomized clinical trial. J Thorac Cardiovasc Surg. 1992;104284- 296
PubMed
Villarino  MEGordon  SMValdon  C  et al.  A cluster of severe postoperative bleeding following open heart surgery. Infect Control Hosp Epidemiol. 1992;13282- 287
PubMed Link to Article
Boldt  JKnothe  CZickmann  BAndres  PDapper  FHempelmann  G Influence of different intravascular volume therapies on platelet function in patients undergoing cardiopulmonary bypass. Anesth Analg. 1993;761185- 1190
PubMed Link to Article
Boldt  JKnothe  CSchindler  EHammermann  HDapper  FHempelmann  G Volume replacement with hydroxyethyl starch solution in children. Br J Anaesth. 1993;70661- 665
PubMed Link to Article
Gall  HKaufmann  Rvon  Ehr MSchumann  KSterry  W Persistierender Pruritus nach Hydroxyäthylstärke-Infusionen: retrospektive Langzeitstudie an 266 Fällen. Hautarzt. 1993;44713- 716
PubMed
Grundmann  TGramer  L Pruritus bei Infusionstherapie mit Hydroxyethylstärke verschiedener Menge. Wehrmed Monatsschr. 1993;247- 48
Haws  RMBaum  M Efficacy of albumin and diuretic therapy in children with nephrotic syndrome. Pediatrics. 1993;911142- 1146
PubMed
Jurecka  WSzepfalusi  ZParth  E  et al.  Hydroxyethylstarch deposits in human skin: a model for pruritus? Arch Dermatol Res. 1993;28513- 19
PubMed Link to Article
Videm  VFosse  ESvennevig  JL Platelet preservation during coronary bypass surgery with bubble and membrane oxygenators: effect of albumin priming. Perfusion. 1993;8409- 415
Link to Article
Laxenaire  MCCharpentier  CFeldman  L Réaction anaphylactoïdes aux substituts colloïdaux du plasma: incidence, facteurs de risque, mécanismses: enquête prospective multicentrique française. Ann Fr Anesth Reanim. 1994;13301- 310
PubMed Link to Article
Desloovere  CKnecht  R Infusionstherapie bei Hörsturz: Reduktion des Juckreizrisikos nach Hydroxyethylstärke (HES) unter Erhalt des Therapieerfolges: eine prospektive randomisierte Studie. Laryngorhinootologie. 1995;74468- 472
PubMed Link to Article
Leunig  ASzeimies  RMWilmes  EGutmann  RStolz  WFeyh  J Klinische und elektronenmikroskopische Untersuchung zur Hörsturztherapie mit der Kombination 10% HES 200/0.5 und Pentoxifyllin. Laryngorhinootologie. 1995;74135- 140
PubMed Link to Article
Tabuchi  Nde  Haan JGallandat  Huet RCBoonstra  PWvan  Oeveren W Gelatin use impairs platelet adhesion during cardiac surgery. Thromb Haemost. 1995;741447- 1451
PubMed
Treib  JHaass  APindur  G  et al.  HES 200/0.5 is not HES 200/0.5: influence of the C2/C6 hydroxyethylation ratio of hydroxyethyl starch (HES) on hemorheology, coagulation and elimination kinetics. Thromb Haemost. 1995;741452- 1456
PubMed
Trumble  ERMuizelaar  JPMyseros  JSChoi  SCWarren  BB Coagulopathy with the use of hetastarch in the treatment of vasospasm. J Neurosurg. 1995;8244- 47
PubMed Link to Article
Tølløfsrud  SSvennevig  JLBreivik  H  et al.  Fluid balance and pulmonary functions during and after coronary artery bypass surgery: Ringer's acetate compared with dextran, polygeline, or albumin. Acta Anaesthesiol Scand. 1995;39671- 677
PubMed Link to Article
Bernard  CAlain  MSimone  CXavier  MJean-Francois  M Hydroxyethylstarch and osmotic nephrosis-like lesions in kidney transplants [letter]. Lancet. 1996;3481595
PubMed Link to Article
Brutocao  DBratton  SLThomas  JRSchrader  PFColes  PGLynn  AM Comparison of hetastarch with albumin for postoperative volume expansion in children after cardiopulmonary bypass. J Cardiothorac Vasc Anesth. 1996;10348- 351
PubMed Link to Article
Cittanova  MLLeblanc  ILegendre  CMouquet  CRiou  BCoriat  P Effect of hydroxyethylstarch in brain-dead kidney donors on renal function in kidney-transplant recipients. Lancet. 1996;3481620- 1622
PubMed Link to Article
Ginès  AFernández-Esparrach  GMonescillo  A  et al.  Randomized trial comparing albumin, dextran 70, and polygeline in cirrhotic patients with ascites treated by paracentesis. Gastroenterology. 1996;1111002- 1010
PubMed Link to Article
Schneider  MValentine  SClarke  GMNewman  MAPeacock  J Acute renal failure in cardiac surgical patients, potentiated by gentamicin and calcium. Anaesth Intensive Care. 1996;24647- 650
PubMed
Treib  JHaass  APindur  G  et al.  Influence of low and medium molecular weight hydroxyethyl starch on platelets during a long-term hemodilution in patients with cerebrovascular diseases. Arzneimittelforschung. 1996;461064- 1066
PubMed
Treib  JHaass  APindur  GTreib  WWenzel  ESchimrigk  K Influence of intravascular molecular weight of hydroxyethyl starch on platelets. Eur J Haematol. 1996;56168- 172
PubMed Link to Article
Wahba  ASendtner  EBirnbaum  DE Fluid resuscitation with Haemaccel vs human albumin following coronary artery bypass grafting. Thorac Cardiovasc Surg. 1996;44178- 182
PubMed Link to Article
Biesenbach  GKaiser  WZazgornik  J Incidence of acute oligoanuric renal failure in dextran 40 treated patients with acute ischemic stroke stage III or IV. Ren Fail. 1997;1969- 75
PubMed Link to Article
Cope  JTBanks  DMauney  MC  et al.  Intraoperative hetastarch infusion impairs hemostasis after cardiac operations. Ann Thorac Surg. 1997;6378- 82
PubMed Link to Article
Dehne  MGMühling  JSablotzki  APapke  GKuntzsch  UHempelmann  G Einfluß von Hydroxyethylstärke-Lösung auf die Nierenfunktion bei operativen Intensivpatienten. Anasthesiol Intensivmed Notfallmed Schmerzther. 1997;32348- 354
PubMed Link to Article
Hedin  HLjungström  KG Prevention of dextran anaphylaxis: ten years experience with hapten dextran. Int Arch Allergy Immunol. 1997;113358- 359
PubMed Link to Article
Metze  DReimann  SSzepfalusi  ZBohle  BKraft  DLuger  TA Persistent pruritus after hydroxyethyl starch infusion therapy: a result of long-term storage in cutaneous nerves. Br J Dermatol. 1997;136553- 559
PubMed Link to Article
Owen  HGBrecher  ME Partial colloid starch replacement for therapeutic plasma exchange. J Clin Apheresis. 1997;1287- 92
PubMed Link to Article
Rock  GSutton  DMFreedman  JNair  RC Pentastarch instead of albumin as replacement fluid for therapeutic plasma exchange: the Canadian Apheresis Group. J Clin Apheresis. 1997;12165- 169
PubMed Link to Article
Saxena  NChauhan  SRamesh  GS A comparison of hetastarch, albumin and Ringer lactate for volume replacement in coronary artery bypass surgery. J Anaesth Clin Pharm. 1997;13117- 120
Stoll  MTreib  JSchenk  JF  et al.  No coagulation disorders under high-dose volume therapy with low-molecular-weight hydroxyethyl starch. Haemostasis. 1997;27251- 258
PubMed
Tigchelaar  IGallandat  Huet RCKorsten  JBoonstra  PWvan  Oeveren W Hemostatic effects of three colloid plasma substitutes for priming solution in cardiopulmonary bypass. Eur J Cardiothorac Surg. 1997;11626- 632
PubMed Link to Article
Treib  JHaass  APindur  G  et al.  Increased haemorrhagic risk after repeated infusion of highly substituted medium molecular weight hydroxyethyl starch. Arzneimittelforschung. 1997;4718- 22
PubMed
Altman  CBernard  BRoulot  DVitte  RLInk  O Randomized comparative multicenter study of hydroxyethyl starch versus albumin as a plasma expander in cirrhotic patients with tense ascites treated with paracentesis. Eur J Gastroenterol Hepatol. 1998;105- 10
PubMed Link to Article
Bothner  UGeorgieff  MVogt  NH Assessment of the safety and tolerance of 6% hydroxyethyl starch (200/0.5) solution: a randomized, controlled epidemiology study. Anesth Analg. 1998;86850- 855
PubMed
Cochrane Injuries Group Albumin Reviewers, Human albumin administration in critically ill patients: systematic review of randomised controlled trials. BMJ. 1998;317235- 240
PubMed Link to Article
Gröchenig  EAlbegger  KDieterich  HJ  et al.  Hydroxyethylstarch-related pruritus: a prospective multicentre investigation of 544 patients. Perfusion. 1998;1162- 69
Herwaldt  LASwartzendruber  SKEdmond  MB  et al.  The epidemiology of hemorrhage related to cardiothoracic operations. Infect Control Hosp Epidemiol. 1998;199- 16
PubMed Link to Article
Tigchelaar  IGallandat  Huet RCBoonstra  PWvan  Oeveren W Comparison of three plasma expanders used as priming fluids in cardiopulmonary bypass patients. Perfusion. 1998;13297- 303
PubMed Link to Article
Deman  APeeters  PSennesael  J Hydroxyethyl starch does not impair immediate renal function in kidney transplant recipients: a retrospective, multicentre analysis. Nephrol Dial Transplant. 1999;141517- 1520
PubMed Link to Article
Goss  GAWeinstein  R Pentastarch as partial replacement fluid for therapeutic plasma exchange: effect on plasma proteins, adverse events during treatment, and serum ionized calcium. J Clin Apheresis. 1999;14114- 121
PubMed Link to Article
Karoutsos  SNathan  NLahrimi  AGrouille  DFeiss  PCox  DJ Thrombelastogram reveals hypercoagulability after administration of gelatin solution. Br J Anaesth. 1999;82175- 177
PubMed Link to Article
Keyser  EJLatter  DAMorin  JEMurshid  AADenis  Fde Varennes  B Pentastarch versus albumin in cardiopulmonary bypass prime: impact on blood loss. J Card Surg. 1999;14279- 286
PubMed Link to Article
Kumle  BBoldt  JPiper  SSchmidt  CSuttner  SSalopek  S The influence of different intravascular volume replacement regimens on renal function in the elderly. Anesth Analg. 1999;891124- 1130
PubMed Link to Article
Omar  MNShouk  TAKhaleq  MA Activity of blood coagulation and fibrinolysis during and after hydroxyethyl starch (HES) colloidal volume replacement. Clin Biochem. 1999;32269- 274
PubMed Link to Article
Sharland  CHuggett  ANielson  MSFriedmann  PS Persistent pruritis after pentastarch infusions in intensive care patients. Anaesthesia. 1999;54500- 501
PubMed Link to Article
Sirtl  CLaubenthal  HZumtobel  VKraft  DJurecka  W Tissue deposits of hydroxyethyl starch (HES): dose-dependent and time-related. Br J Anaesth. 1999;82510- 515
PubMed Link to Article
Canver  CCNichols  RD Use of intraoperative hetastarch priming during coronary bypass. Chest. 2000;1181616- 1620
PubMed Link to Article
Knutson  JEDeering  JAHall  FW  et al.  Does intraoperative hetastarch administration increase blood loss and transfusion requirements after cardiac surgery? Anesth Analg. 2000;90801- 807
PubMed Link to Article
Morgan  PWBerridge  JC Giving long-persistent starch as volume replacement can cause pruritus after cardiac surgery. Br J Anaesth. 2000;85696- 699
PubMed Link to Article
Torchia  MGDanzinger  RG Perioperative blood transfusion and albumin administration are independent risk factors for the development of postoperative infections after colorectal surgery. Can J Surg. 2000;43212- 216
PubMed
Christidis  CMal  FRamos  J  et al.  Worsening of hepatic dysfunction as a consequence of repeated hydroxyethylstarch infusions. J Hepatol. 2001;35726- 732
PubMed Link to Article
Howard  GDownward  GBowie  D Human serum albumin induced hypotension in the postoperative phase of cardiac surgery. Anaesth Intensive Care. 2001;29591- 594
PubMed
Huraux  CAnkri  AAEyraud  D  et al.  Hemostatic changes in patients receiving hydroxyethyl starch: the influence of ABO blood group. Anesth Analg. 2001;921396- 1401
PubMed Link to Article
Jonville-Béra  APAutret-Leca  EGruel  Y Acquired type I von Willebrand's disease associated with highly substituted hydroxyethyl starch. N Engl J Med. 2001;345622- 623
PubMed Link to Article
Kimme  PJannsen  BLedin  TGupta  AVegfors  M High incidence of pruritus after large doses of hydroxyethyl starch (HES) infusions. Acta Anaesthesiol Scand. 2001;45686- 689
PubMed Link to Article
Murphy  MCarmichael  AJLawler  PGWhite  MCox  NH The incidence of hydroxyethyl starch-associated pruritus. Br J Dermatol. 2001;144973- 976
PubMed Link to Article
Petroni  KCGreen  RBirmingham  S Hextend is a safe alternative to 5% human albumin for patients undergoing elective cardiac surgery [abstract]. Anesthesiology. 2001;95A198
Schortgen  FLacherade  JCBruneel  F  et al.  Effects of hydroxyethylstarch and gelatin on renal function in severe sepsis: a multicentre randomised study. Lancet. 2001;357911- 916
PubMed Link to Article
Wilkes  MMNavickis  RJSibbald  WJ Albumin versus hydroxyethyl starch in cardiopulmonary bypass surgery: a meta-analysis of postoperative bleeding. Ann Thorac Surg. 2001;72527- 534
PubMed Link to Article
Wilkes  MMNavickis  RJ Patient survival after human albumin administration: a meta-analysis of randomized, controlled trials. Ann Intern Med. 2001;135149- 164
PubMed Link to Article
von Hoegen  IWaller  C Safety of human albumin based on spontaneously reported serious adverse events. Crit Care Med. 2001;29994- 996
PubMed Link to Article
Kuo  STHsu  WCYoung  YH Dextran-induced pulmonary edema in patients with sudden deafness. Otol Neurotol. 2002;23661- 664
PubMed Link to Article
Trull  AHughes  VCooper  D  et al.  Influence of albumin supplementation on tacrolimus and cyclosporine therapy early after liver transplantation. Liver Transpl. 2002;8224- 232
PubMed Link to Article
Lucas  CEWeaver  DHiggins  RFLedgerwood  AMJohnson  SDBouwman  DL Effects of albumin versus non-albumin resuscitation on plasma volume and renal excretory function. J Trauma. 1978;18564- 570
PubMed Link to Article

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