Animal data have generally shown a beneficial effect of
colloids in
trauma resuscitation, with improvements in capillary leak demonstrated in lung, intestine and brain. In most studies, hydroxyethyl
starch resuscitation was more effective than
crystalloid and decreased markers of inflammatory processes were observed.
Brain injury in animals was attenuated with
colloids. In uncontrolled haemorrhage,
resuscitation with
colloid increased
bleeding and mortality.Human studies have also failed to confirm the suggestion that
albumin resuscitation may be associated with a worse outcome in
head injury. However, there is a strong suggestion that aggressive prehospital
resuscitation, particularly with
colloid, may be harmful. Studies in
burns have consistently shown an improvement in the tendency to fluid overload with the inclusion of
colloid in the
resuscitation strategy, but so far no outcome benefit has been shown.Two studies of general
trauma resuscitation have shown apparent benefit from the use of HES in early
resuscitation with reductions in mortality and in renal injury.
SUMMARY: