Pharmacology and clinical use of plasma expanders.

Plasma expanders are colloidal solutions that expand the circulating blood volume more than isotonic crystalloids and are among the most commonly used fluids in critical care and perioperative medicine worldwide. We begin our review of these agents by introducing the modified Starling model, which incorporates the fundamental physiologic role of the endothelial glycocalyx in transcapillary fluid movement. Next, we individually discuss each fluid, starting with their relevant pharmacological properties before delving into the trials on their clinical use. Human trial data on gelatins and dextrans are scarce, making their routine use difficult to justify outside resource-poor settings. Trials on the use of hydroxyethyl starch in critical care imply increased risk of kidney injury, coagulopathy and, possibly, mortality; whether these harms apply to the surgical setting remains an area of debate and ongoing study, but there is no compelling evidence to support the routine use of hydroxyethyl starch in the operating room. Multiple trials suggest that albumin is a safe, albeit more expensive, alternative to crystalloid use in the intensive care unit, with secondary analyses suggesting harm in traumatic brain injury and benefit in septic shock. Finally, more data are required to better define the role of albumin in perioperative medicine. [ABSTRACT FROM AUTHOR]