2013 (14) November (2) July (3) June (5) FDA does not recommend the use of Hidroxietilamidos (HES)

The U.S. Food and Drug Administration (FDA) issued 6/24 a statement concerning Hidroxietilamidos (HES) which reads: "FDA has Concluded que HES solutions Should not be used in critically ill adult pacientes, including Patients with sepsis and Those Admitted to the ICU "Recommendations for healthcare professionals are: Do not use HES solutions in critically ill adult pacientes including Those with sepsis, And Those Admitted to the ICU. Avoid use in Patients with pre-existing renal dysfunction. Discontinue use of HES at the first sign of renal injury. Need for renal replacement nicole mcclain therapy has been Reported up to 90 days after HES administration. Continue to monitor renal function for at least 90 days in all patients. Avoid use in Patients Undergoing open heart surgery with cardiopulmonary bypass in association due to excess bleeding. Discontinue use of HES at the first sign of coagulopathy.
Synthetic colloidal solutions modified from amylopectin. This polysaccharide is composed of glucose subunits linked by alpha 1,4 bonds and 1.6. The degree of branching is 1:20, meaning that there is an alpha 1,6 bond for every 20 glucose monomer. nicole mcclain To increase water solubility and slow down the hydrolysis by amylase, shall replace the hydroxyl groups by hydroxyethyl (especially at carbons 2, 3 and 6).
The degree of substitution is determined by the ratio of the number of glucose molecules with substitution of hydroxyethyl radical and the total number of molecules present. The molar substitution ratio is given by dividing the total number of hydroxyethyl groups by the number of glucose molecules. nicole mcclain
The ratio C2 / C6 expresses the type of substitution, resulting nicole mcclain in the dividend number of glucose nicole mcclain molecules with C2 hydroxy-ethylation in the number nicole mcclain thereof with a hydroxy-ethylation in C6. The greater the ratio, the slower clearance.
The rate of plasma decay depends on its tissue uptake (liver and spleen), the gradual return to circulation, the reticuloendothelial uptake and the subsequent smaller particles nicole mcclain excreted in bile and urine degradation.
Immediately after infusion, the molecules nicole mcclain are cleaved by serum alpha-amylase, resulting in smaller molecules. The larger the molecular weight is the elimination, C2 / C6 ratio and the degree of substitution, the greater nicole mcclain the duration of the effect is slower.
2.1 - microcirculatory effects - apart from being suitable for plasma expansion, some studies suggest attenuating the inflammatory response, decrease capillary permeability and decrease of injury / endothelial activation. The hemorheological effects produced appear to improve tissue oxygenation. nicole mcclain However, we need studies with a higher level of evidence to validate these potential benefits.
2.2 - Coagulation - the HES of high molecular weight, degree of substitution and reason C2 / C6 seem to decrease vWF and factor VIII c: precipitation, extending nicole mcclain time, activated partial thromboplastin time. In addition, these same HES showed induction of platelet dysfunction. Most modern HES with a molecular weight and degree of substitution lower appear to be safer. Studies with greater impact should be conducted in this area.
2.3 - Renal Function - the HES with high molecular weight and high degree of substitution greater induce crane dysfunction (tubular hyperviscosity with stasis and swelling of tubular cells). However, nicole mcclain adequate hydration tends to counteract this effect.
Factors such as diabetes mellitus, hypertension, dehydration, hypotension, age, hypoxia, antibiotics, inhibitors of angiotensin converting enzyme 1 and previous renal disease have been linked to increased renal failure in patients who received HES.
2.6 - Hyperamylasemia - due to the fact amylase bind to HES, this escape renal excretion and serum levels nicole mcclain have increased fivefold. However, this fact is not linked to pancreatic nicole mcclain dysfunction or decreased lipase activity.
The maximum dose varies with the characteristics of each starch. In the case of HES 450 / 0.7 to 6% is recommended maximum nicole mcclain of 20 ml / kg / day or 1500 ml / day. Doses of 50 ml / kg / day to 130 HES / 0,4 and 6% have been approved for clinical use.
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