3 Artificial colloids in clinical practice: pros and cons

Abstract

Maintenance/achievement of normovolaemia, haemodynamic stability and adequate nutritive blood flow is the main objective of clinical fluid treatment. These goals are more effectively reached with the choice of artificial colloids rather than balanced salt solutions for plasma volume support. Commonly used artificial colloids are dextrans, gelatins and different hydroxyethyl starch (HES) preparations, including pentastarch and pentafractions of HES. With the choice of colloid, the plasma volume expanding efficacy, intravascular persistence, haemorheologic effectiveness and inherent specific pharmacological effects on haemostasis, red cell aggregation, platelet function, plasma viscosity and blood corpuscle-endothelial cell interactions of the colloid should be considered. In this chapter, colloid characteristics are related to the clinical efficacy of different colloidal preparations for intentional haemodilution and plasma volume support in patients with vascular disease or acute ischaemic stroke. Furthermore, the choice of colloid for perioperative fluid therapy and resuscitation of shock and trauma conditions is considered.