Balanced Volume Replacement Strategy: Fact or Fiction?

  • J. Boldt


Adequate volume restoration in the hypovolemic patient appears to be essential to stave non-compensatory, irreversible shock and subsequently to avoid development of multiple organ dysfunction syndrome. Vigorous optimization of the circulation is a prerequisite in the management of such patients. This maneuver is aimed at guaranteeing stable macro- and micro-hemodynamics, while avoiding excessive fluid accumulation in the interstitial tissue. The choice of fluid for this purpose engenders considerable controversy and there is still a dispute over the beneficial and adverse effects of each fluid type.


Platelet Function Multiple Organ Dysfunction Syndrome Hydroxyethyl Starch Volume Replacement Abdominal Aortic Aneurysm Repair 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Prough DS (2000) Acidosis associated with perioperative saline administration. Anesthesiology 93:1184–1187CrossRefGoogle Scholar
  2. 2.
    Kellum JA (2002) Saline-induced hyperchloremic metabolic acidosis. Crit Care Med 30:259–261PubMedCrossRefGoogle Scholar
  3. 3.
    Wilkes NJ, Woolf R, Mutch M, et al (2001) The effects of balanced versus saline-based hetastarch and crystalloid solutions on acid-base and electrolyte status and gastric mucosal perfusion in elderly surgical patients. Anesth Analg 93:811–816PubMedCrossRefGoogle Scholar
  4. 4.
    Wilcox CS (1983) Regulation of renal blood flow by plasma chloride. J Clin Invest 71:726–735PubMedCrossRefGoogle Scholar
  5. 5.
    Williams EL, Hildebrand KL, McCormick SA, Bedel MJ (1999) The effect of intravenous lactated Ringer’s solution versus 0.9% sodium chloride solution on serum osmolarity in human volunters. Anesth Analg 88:999–1003PubMedCrossRefGoogle Scholar
  6. 6.
    Waters J H, Gottlieb A, Schoenwald P, Popovich MJ, Sprung J, Nelson DR (2001) Normal saline versus Ringer’s lactate solutions for intraoperative fluid management in patients undergoing abdominal aortic aneurysm repair: an outcome study. Anesth Analg 93:817–822PubMedCrossRefGoogle Scholar
  7. 7.
    Scheingraber S, Rehm M, Finsterer U (1999) Rapid saline infusion produces hyperchloremic acidois in patient gynecologic surgery. Anesthesiology 90:1265–1270PubMedCrossRefGoogle Scholar
  8. 8.
    Rehm M, Orth V, Scheingraber S, Kreimeier U, Brechelsbauer H, Finsterer U (2000) Acid-base changes cause by 5% albumin versus 6% hydroxyethyl starch solution in patients undergoing acute normovolemic hemodilution. Anesthesiology 93:1174–1183PubMedCrossRefGoogle Scholar
  9. 9.
    Waters JH, Bernstein CA (2000) Dilutional acidosis following hetastarch or albumin in healthy volunteers. Anesthesiology 93:1184–1187PubMedCrossRefGoogle Scholar
  10. 10.
    Funk W, Baldinger V (1995) Micro circulatory perfusion during volume therapy. Anesthesiology 82:975–982PubMedCrossRefGoogle Scholar
  11. 11.
    Norberg A, Brauer KI, Prough DS, et al (2005) Volume turnover kinetics of fluid shifts after hemorrhage, fluid infusion, and the combination of hemorrhage and fluid infusion in sheep. Anesthesiology 102:985–994PubMedCrossRefGoogle Scholar
  12. 12.
    Gan TJ, Bennett-Guerrero E, Phillips-Bute B et al (1999) Hextend®, a physiologically balanced plasma expander for large volume use in major surgery: a randomized phase III clinical trial. Anesth Analg 88:992–998PubMedCrossRefGoogle Scholar
  13. 13.
    Wilkes NJ, Woolf RL, Powanda MC, et al (2002) Hydroxyethyl starch in balanced electrolyt solution (Hextend) — pharmacokinetic and pharmacodynamic profiles in healthy volunteers. Anesth Analg 94:538–544PubMedCrossRefGoogle Scholar
  14. 14.
    Kozek-Langenecker SA (2005) Effects of hydroxyethyl starch solutions on hemostasis. Anesthesiology 103:654–660PubMedCrossRefGoogle Scholar
  15. 15.
    deJonge E, Levi M (2001) Effects of different plasma substitutes on blood coagulation: a comparative review. Crit Care Med 29:1261–1267CrossRefGoogle Scholar
  16. 16.
    Stögermüller B, Stark J, Willschke H, Felfernig M, Hoerauf K, Kozek-Langenecker SA (2000) The effect of hydroxyethylstarch 200 kD on platelet function. Anesth Analg 91:823–827PubMedCrossRefGoogle Scholar
  17. 17.
    Franz A, Bräunlich P, Gamsjäger T, Felfernig M, Gustorff B, Kozek-Langenecker SA (2001) The effects of hydroxyethyl starches of varying molecular weights on platelet function. Anesth Analg 92:1402–1407PubMedCrossRefGoogle Scholar
  18. 18.
    Deusch E, Thaler U, Kozek-Langenecker SA (2004) The effects of high molecular weight hydroxyethyl starch solutions on platelets. Anesth Analg 99:665–668PubMedCrossRefGoogle Scholar
  19. 19.
    Bick RL (1995) Evaluation of a new hydroxyethyl starch preparation (Hextend) on selected coagulation parameters. Clin Appl Thrombosis/Hemostasis 1:215–229Google Scholar
  20. 20.
    Roche AM, James MF, Grocott MP, Mythen MG (2002) Coagulation effects of in vitro serial haemodilution with a balanced electrolyte hetastarch solution compared with a saline-based hetastarch solution and lactated Ringer’s solution. Anaesthesia 57:950–955PubMedCrossRefGoogle Scholar
  21. 21.
    Boldt J, Haisch G, Suttner S, Kumle B, Schellhaass A (2002) Effects of a new modified, balanced hydroxyethyl starch preparation (Hextend?) on measures of coagulation. Br J Anaesth 89:722–728PubMedCrossRefGoogle Scholar
  22. 22.
    Blaicher AM, Reiter WJ, Blaicher W, et al (1998) The effect of hydroxyethyl starch on platelet aggregation in vitro. Anesth Analg 86:1318–1321PubMedCrossRefGoogle Scholar
  23. 23.
    Konrad CJ, Markl TJ, Schuepfer K, Schmeck J, Gerber HR (2002) In vitro effects of different medium molecular hydroxyethyl starch solutions and lactated Ringer’s solution on coagulation using SONOCLOT. Anesth Analg 90:274–279CrossRefGoogle Scholar
  24. 24.
    Haisch G, Boldt J, Krebs C, Kumle B, Suttner S, Schulz A (2001) The influence of intravascular volume therapy with a new hydroxyethyl starch preparation (6% HES 130/0.4) on coagulation in patients undergoing major abdominal surgery. Anesth Analg 92:565–571PubMedCrossRefGoogle Scholar
  25. 25.
    Waitzinger J, Bepperling F, Pabst G, Opitz J (1998) Pharmacokinetics and tolerability of a new hydroxyethylstarch (HES) specification (HES 130/0.4) after single-dose infusion of 6% or 10% solution in healthy volunteers. Clin Drug Invest 16:151–160CrossRefGoogle Scholar
  26. 26.
    Jungheinrich C, Sauermann W, Bepperling F, Vogt NH (2004) Volume efficacy and reduced influence on measures of coagulation using hydroxyethyl starch 130/0.4 (6%) with an optimised in vivo molecular weight in orthopaedic surgery: a randomised, double-blind study. Drugs R D 5:1–9PubMedCrossRefGoogle Scholar
  27. 27.
    Sander O, Reinhart K, Meier-Hellmann A (2003) Eqivalence of hydroxyethyl starch HES 130/0.4 and HES 200/0.5 for postoperative volume replacement in major gynaecological surgery. Acta Anaesthesiol Scand 47:1151–1158PubMedCrossRefGoogle Scholar
  28. 28.
    Boldt J Schöllhorn T, Schulte G, Pabsdorf M (2006) A total balanced volume replacement strategy using a new balanced hydroxyethylstarch preparation (HES 130/0.42) in patients undergoing major abdominal surgery. Eur J Anaesthesiol 23:1–9CrossRefGoogle Scholar
  29. 29.
    Brill SA, Stewart TR, Brundage SI, Schreiber MA (2002) Base deficit does not predict mortality when secondary to hyperchloremic acidosis. Shock 17:459–462PubMedCrossRefGoogle Scholar
  30. 30.
    Boldt J, Mengistu A, Wolf M (2006) A new plasma-adapted hydroxyethylstarch (HES) preparation — in vitro coagulation studies using thrombelastography and whole blood aggregometry. Anesth Analg (in press)Google Scholar
  31. 31.
    Kellum JA (2002) Fluid resuscitation and hyperchloremic acidosis in experimental sepsis: improved short-term survival and acid-base balance with Hextend compared with saline. Crit Care Med 30:300–530PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media Inc. 2007

Authors and Affiliations

  • J. Boldt
    • 1
  1. 1.Department of Anesthesiology and Intensive Care MedicineKlinikum der Stadt LudwigshafenLudwigshafenGermany

Personalised recommendations