Hidroxietil almidón. Controversias revisadas
Hydroxyeyhyl starch: Controversies revisited .
J Anaesthesiol Clin Pharmacol [serial online] 2014 [cited 2014 Oct 14];30:472-80.
Datta R, Nair R, Pandey A, Kumar N, Sahoo T.
Abstract
Hydroxyethyl starch (HES) family has been one of the cornerstones in fluid management for over four decades. Recent evidence from clinical studies and meta-analyses has raised few concerns about the safety of these fluids, especially in certain subpopulations of patients. High-quality clinical trials and meta-analyses have emphasized nephrotoxic effects, increased risk of bleeding, and a trend toward higher mortality in these patients after the use of HES solutions. Scientific evidence was derived from international guidelines, aggregated research literature, and opinion-based evidence was obtained from surveys and other activities (e.g., internet postings). On critical analysis of the current data available, it can be summarized that further large scale trials are still indicated before HES can be discarded.
Keywords: Controversies, hydroxyethyl starch, colloids
http://www.joacp.org/text.asp?2014/30/4/472/142801
http://www.joacp.org/downloadpdf.asp?issn=0970-9185;year=2014;volume=30;issue=4;spage=472;epage=480;aulast=Datta;type=2
El debate sobre la seguridad del Hidroxietil almidón es importante, pero debe basarse en hechos
Debate on HES safety is important, but must be based on facts.
Haase N, Müller R, Perner A.
Scand J Trauma Resusc Emerg Med. 2013 Aug 30;21:66. doi: 10.1186/1757-7241-21-66.
Abstract
The Scandinavian Starch for Severe Sepsis / Septic Shock (6S) trial showed that hydroxyethyl starch was harmful compared to Ringer's acetate in patients with severe sepsis when used according to clinical practice and in alignment with the recommendations by the manufactures and authorities. The different interpretation by Chapell and Jacob's rely on misreading of the trial publication and is not supported by the trial data. Several hypotheses may be made regarding less harmful ways of using HES in critically ill patients, but clinicians, guideline committee members and authorities need to acknowledge that such safer ways have not yet been identified.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3765941/pdf/1757-7241-21-66.pdf
Efectos de los coloides sintéticos sobre el estres oxidativo y la respuesta inflamatoria en shock hemorrágico. Comparación entre hidroxietil almidón 130/0.4 y hidroxietil almidón 200/0.5 y gelatina succinilada
Effects of synthetic colloids on oxidative stress and inflammatory response in hemorrhagic shock: comparison of hydroxyethyl starch 130/0.4, hydroxyethyl starch 200/0.5, and succinylated gelatin.
Chen G, You G, Wang Y, Lu M, Cheng W, Yang J, Zhao L, Zhou H.
Crit Care. 2013 Jul 12;17(4):R141. doi: 10.1186/cc12820.
Abstract
INTRODUCTION: This study compared the effects of hydroxyethyl starch 130/0.4, hydroxyethyl starch 200/0.5, and succinylated gelatin on oxidative stress and the inflammatory response in a rodent hemorrhagic shock model.METHODS: Sodium pentobarbital-anesthetized adult male Wistar rats (200 g to 220 g) were
subjected to a severe volume-controlled hemorrhage using arterial blood withdrawal (
30 mL/kg to 33 mL/kg) and resuscitated with a colloid solution at the same volume as blood withdrawal (hydroxyethylstarch 130/0.4, hydroxyethyl starch 200/0.5, or succinylated gelatin). Arterial blood gas parameters were monitored. Malondialdehyde (MDA) content and myeloperoxidase (MPO) activity in the liver, lungs, intestine, and brain were measured two hours after resuscitation. The levels of tumor necrosis factor-alpha (TNF-α) and interleukin-6 in the intestine were also measured. RESULTS: Infusions of hydroxyethyl starch 130/0.4, but not hydroxyethyl starch 200/0.5 or succinylated gelatin, significantly reduced MDA levels and MPO activity in the liver, intestine, lungs and brain, and it also inhibited the production of TNF-α in the intestine two hours after resuscitation. However, no significant difference between hydroxyethyl starch 200/0.5 and succinylated gelatin was observed. CONCLUSIONS: Hydroxyethyl starch 130/0.4, but not hydroxyethyl starch 200/0.5 or succinylated gelatin, treatment after hemorrhagic shockameliorated oxidative stress and the inflammatory response in this rat model. No significant differences were observed after hydroxyethyl starch200/0.5 or succinylated gelatin administration at doses of approximately 33 mL/kg
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056655/pdf/cc12820.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Hydroxyeyhyl starch: Controversies revisited .
J Anaesthesiol Clin Pharmacol [serial online] 2014 [cited 2014 Oct 14];30:472-80.
Datta R, Nair R, Pandey A, Kumar N, Sahoo T.
Abstract
Hydroxyethyl starch (HES) family has been one of the cornerstones in fluid management for over four decades. Recent evidence from clinical studies and meta-analyses has raised few concerns about the safety of these fluids, especially in certain subpopulations of patients. High-quality clinical trials and meta-analyses have emphasized nephrotoxic effects, increased risk of bleeding, and a trend toward higher mortality in these patients after the use of HES solutions. Scientific evidence was derived from international guidelines, aggregated research literature, and opinion-based evidence was obtained from surveys and other activities (e.g., internet postings). On critical analysis of the current data available, it can be summarized that further large scale trials are still indicated before HES can be discarded.
Keywords: Controversies, hydroxyethyl starch, colloids
http://www.joacp.org/text.asp?2014/30/4/472/142801
http://www.joacp.org/downloadpdf.asp?issn=0970-9185;year=2014;volume=30;issue=4;spage=472;epage=480;aulast=Datta;type=2
El debate sobre la seguridad del Hidroxietil almidón es importante, pero debe basarse en hechos
Debate on HES safety is important, but must be based on facts.
Haase N, Müller R, Perner A.
Scand J Trauma Resusc Emerg Med. 2013 Aug 30;21:66. doi: 10.1186/1757-7241-21-66.
Abstract
The Scandinavian Starch for Severe Sepsis / Septic Shock (6S) trial showed that hydroxyethyl starch was harmful compared to Ringer's acetate in patients with severe sepsis when used according to clinical practice and in alignment with the recommendations by the manufactures and authorities. The different interpretation by Chapell and Jacob's rely on misreading of the trial publication and is not supported by the trial data. Several hypotheses may be made regarding less harmful ways of using HES in critically ill patients, but clinicians, guideline committee members and authorities need to acknowledge that such safer ways have not yet been identified.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3765941/pdf/1757-7241-21-66.pdf
Efectos de los coloides sintéticos sobre el estres oxidativo y la respuesta inflamatoria en shock hemorrágico. Comparación entre hidroxietil almidón 130/0.4 y hidroxietil almidón 200/0.5 y gelatina succinilada
Effects of synthetic colloids on oxidative stress and inflammatory response in hemorrhagic shock: comparison of hydroxyethyl starch 130/0.4, hydroxyethyl starch 200/0.5, and succinylated gelatin.
Chen G, You G, Wang Y, Lu M, Cheng W, Yang J, Zhao L, Zhou H.
Crit Care. 2013 Jul 12;17(4):R141. doi: 10.1186/cc12820.
Abstract
INTRODUCTION: This study compared the effects of hydroxyethyl starch 130/0.4, hydroxyethyl starch 200/0.5, and succinylated gelatin on oxidative stress and the inflammatory response in a rodent hemorrhagic shock model.METHODS: Sodium pentobarbital-anesthetized adult male Wistar rats (200 g to 220 g) were
subjected to a severe volume-controlled hemorrhage using arterial blood withdrawal (
30 mL/kg to 33 mL/kg) and resuscitated with a colloid solution at the same volume as blood withdrawal (hydroxyethylstarch 130/0.4, hydroxyethyl starch 200/0.5, or succinylated gelatin). Arterial blood gas parameters were monitored. Malondialdehyde (MDA) content and myeloperoxidase (MPO) activity in the liver, lungs, intestine, and brain were measured two hours after resuscitation. The levels of tumor necrosis factor-alpha (TNF-α) and interleukin-6 in the intestine were also measured. RESULTS: Infusions of hydroxyethyl starch 130/0.4, but not hydroxyethyl starch 200/0.5 or succinylated gelatin, significantly reduced MDA levels and MPO activity in the liver, intestine, lungs and brain, and it also inhibited the production of TNF-α in the intestine two hours after resuscitation. However, no significant difference between hydroxyethyl starch 200/0.5 and succinylated gelatin was observed. CONCLUSIONS: Hydroxyethyl starch 130/0.4, but not hydroxyethyl starch 200/0.5 or succinylated gelatin, treatment after hemorrhagic shockameliorated oxidative stress and the inflammatory response in this rat model. No significant differences were observed after hydroxyethyl starch200/0.5 or succinylated gelatin administration at doses of approximately 33 mL/kg
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4056655/pdf/cc12820.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
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