Summary
Colloid solutions have been developed and used over the past 70 years as expanders of the intravascular space, based on an understanding of Starling’s law. Increasing osmotic pressure with colloidal products has remained an attractive theoretical premise for volume resuscitation. Indeed, colloids have been shown to increase osmotic pressure in clinical practice; however, the effects are shortlived. Lower molecular weight colloids exert a larger initial osmotic effect, but are rapidly cleared from the circulation. Larger molecules exert a smaller osmotic pressure that is sustained longer.
The main drawback to colloid therapy lies in pathological states with endothelial injury and capillary leak, precisely the clinical scenario where colloids are commonly given. The colloid solution may leak into the interstitium and remain there exerting an osmotic gradient, pulling additional water into the interstitium.
There are 4 general types of colloid products available for clinical use. Albumin is the predominant plasma protein and remains the standard against which other colloids are compared. Albumin, pooled from human donors, is in short supply and remains expensive. Dextrans have been used to prevent deep venous thrombosis and to lower blood viscosity during surgery. Hetastarch has been widely used as a plasma volume expander. It provides equivalent plasma volume expansion to albumin, but has been shown to alter clotting parameters in studies (prolonging the activated partial thromboplastin time and prothrombin time). Although severe coagulopathies have been reported in sporadic cases, hetastarch has not been shown to increase postoperative bleeding compared with albumin therapy, even in large doses (3 L/day).
Despite some theoretical advantages compared with crystalloid therapy, colloid administration has not been shown to decrease the risk of acute lung injury or to improve survival. Specific indications for colloid products include hypoproteinaemic or malnourished states, patients who require plasma volume expansion who are unable to tolerate larger amounts of fluid, orthopaedic and reconstructive procedures requiring prevention of thrombus formation and leukapheresis.
Similar content being viewed by others
References
Weil MH, Morissette M, Michaels S, et al. Routine plasma colloid osmotic pressure measurements. Crit Care Med 1974 Sep–Oct; 2(5): 229–34
Webb AR, Barclay SA, Bennett ED. In vitro colloid osmotic pressure of commonly used plasma expanders and substitutes: a study of the diffusibility of colloid molecules. Intensive Care Med 1989; 15(2): 116–20
Starling EH. On the absorption of fluids from the connective tissues spaces. J Physiol 1896; 19: 312–26
Taylor AE. Capillary fluid filtration: Starling forces and lymph flow. Circ Res 1981 Sep; 49(3): 557–75
Barclay SA, Bennett ED. The direct measurement of plasma colloid osmotic pressure is superior to colloid osmotic pressure derived from albumin or total protein. Intensive Care Med 1987; 13(2): 114–8
Billmeyer FW. Measuring the weight of giant molecules. Chemistry 1966; 39: 8–14
Fleck A, Raines G, Hawker F, et al. Increased vascular permeability: a major cause of hypoalbuminaemia in disease and injury. Lancet 1985; Apr 6; I(8432): 781–4
Mishler JM. Synthetic plasma volume expanders — their pharmacology, safety and clinical efficacy. Clin Haematol 1984 Feb; 13(1): 75–92
Nearman HS, Herman ML. Toxic effects of colloids in the intensive care unit. Crit Care Clin 1991 Jul; 7(3): 713–23
Lamke LO, Liljedahl SO. Plasma volume expansion after infusion of 5%, 20% and 25% albumin solutions in patients. Resuscitation 1976; 5(2): 85–92
Ring J, Messmer K. Incidence and severity of anaphylactoid reactions to colloid volume substitutes. Lancet 1977 Feb; I(8009): 466–9
Kovalik SG, Ledgerwood AM, Lucas CE, et al. The cardiac effect of altered calcium homeostasis after albumin resuscitation. J Trauma 1981 Apr; 21(4): 275–9
Ledgerwood AM, Lucas CE. Postresuscitation hypertension, etiology, morbidity and treatment. Arch Surg 1974 Apr; 108(4): 531–8
Gore DC, Dalton JM, Gehr TW. Colloid infusions reduce glomerular filtration in resuscitated burn patients. J Trauma 1996 Mar; 40(3): 356–60
Lucas CE. Renal considerations in the injured patient. Surg Clin North Am 1982 Feb; 62(1): 133–48
Klein GL. The aluminum content of parenteral solutions: current status. Nutr Rev 1991 Mar; 49(3): 74–9
Salmon JB, Mythen MG. Pharmacology and physiology of colloids. Blood Rev 1993 Jun; 7(2): 114–20
Bergqvist D. Dextran and haemostasis: a review. Acta Chir Scand 1982; 148(8): 633–40
Aberg M, Hedner U, Bergentz SE. Effect of dextran on factor VIII (antihemophilic factor) and platelet function. Ann Surg 1979 Feb; 189(2): 243–7
Laubenthal H, Messmer K. Allergic reactions to dextrans. In: Baron JF, editor. Plasma volume expansion. Paris: Arnette Blackwell, 1992
Mishler JM, Hester JP, Heustis DW, et al. Dosage and scheduling regimens for erythrocyte-sedimenting macromolecules. J Clin Apheresis 1983; 1(3): 130–43
Strauss RG, Stump DC, Henriksen RA, et al. Effects of hydroxyethyl starch on fibrinogen, fibrin clot formation, and fibrinolysis. Transfusion 1985 May–Jun; 25(3): 230–4
Alexander B, Odake K, Lawlor D, et al. Coagulation, hemostasis, and plasma expanders: a quarter century enigma. Fed Proc 1975 May; 34(6): 1429–40
Stump DC, Strauss RG, Henriksen RA, et al. Effects of hydroxyethyl starch on blood coagulation, particularly Factor VIII. Transfusion 1985 May–Jun; 25(4): 349–54
Gold MS, Russo J, Tissot M, et al. Comparison of hetastarch to albumin for perioperative bleeding in patients undergoing abdominal aortic aneurysm surgery: a prospective, randomized study. Ann Surg 1990 Apr; 211(4): 482–5
Brutocao D, Bratton SL, Thomas JR, et al. Comparison of hetastarch with albumin for postoperative volume expansion in children after cardiopulmonary bypass. J Cardiothorac Vasc Anesth 1996 Apr; 10(3): 348–51
Villarino ME, Gordon SM, Valdon C, et al. A cluster of severe postoperative bleeding following open heart surgery. Infect Control Hosp Epidemiol 1992 May; 13(5): 282–7
Dienes HP, Gerharz CD, Wagner R, et al. Accumulation of hydroxyethyl starch (HES) in the liver of patients with renal failure and portal hypertension. J Hepatol 1986; 3(2): 223–7
London MJ, Ho JS, Triedman JK, et al. A randomized clinical trial of 10% pentastarch (low molecular weight hydroxyethyl starch) versus 5% albumin for plasma volume expansion after cardiac operations. J Thorac Cardiovasc Surg 1989 May; 97(5): 785–97
Rackow EC, Mecher C, Astiz ME, et al. Effects of pentastarch and albumin infusion on cardiorespiratory function and coagulation in patients with severe sepsis and systemic hypoperfusion. Crit Car Med 1989 May; 17(5): 394–8
Brazeal BA, Honeycutt D, Traber LD, et al. Pentafraction for superior resuscitation of the ovine thermal burn. Crit Care Med 1995 Feb; 23(2): 332–39
Yeh T, Parmar JM, Rebeyka IM, et al. Limiting edema in neonatal cardiopulmonary bypass with narrow-range molecular weight hydroxyethyl starch. J Thorac Cardiovasc Surg 1992 Sep; 104(3): 659–65
Saddler JM, Horsey PJ. The new generation gelatins. Anaesthesia 1987 Sept; 42(9): 998–1004
Lundsgaard-Hansen P, Tschirren B. Clinical experience with 120,000 units of modified fluid gelatin. Dev Biol Stand 1980; 48: 251–6
Tranbaugh RF, Elings VB, Christensens J, et al. Determinants of pulmonary interstitial fluid accumulation after trauma. J Trauma 1982 Oct; 22(10): 820–6
Weaver DW, Ledgerwood AM, Lucas CE, et al. Pulmonary effects of albumin resuscitation for severe hypovolemic shock. Arch Surg 1978 Apr; 113(4): 387–92
Holcroft JW, Trunkey DD. Pulmonary extravasation of albumin during and after hemorrhagic shock in baboons. J Surg Res 1975 Feb; 18(2): 91–7
Robin ED, Carey LC, Grevik A, et al. Capillary leak syndrome with pulmonary edema. Arch Intern Med 1972 Jul; 130(1): 66–71
Appel P, Shoemaker WC. Evaluation of fluid therapy in advanced respiratory failure. Crit Care Med 1981 Dec; 9(12): 862–9
Imm A, Carlson RW. Fluid resuscitation in circulatory shock. Crit Care Clinics 1993 Apr; 9(2): 313–33
Mackersie RC, Durelle J. Differential clearance of colloid and crystalloid solutions from the lung. J Trauma 1993 Sep; 35(3): 448–53
Goodman BE, Kim KJ, Crandall ED. Evidence for active sodium transport across the alveolar epithelium of isolated rat lung. J Appl Physiol 1987 Jun; 62(2): 2460–6
Goodman BE, Anderson JL, Clemens JW. Evidence for regulation of sodium transport from airspace to vascular space by cAMP. Am J Physiol 1989 Aug; 257(2 Pt 1): 86–93
Ratner LE, Smith GW. Intraoperative fluid management. Surg Clin North Am 1993 Apr; 73(2): 229–41
Velanovich V. Crystalloid versus colloid fluid resuscitation: a meta-analysis of mortality. Surgery 1989 Jan; 105(1): 65–71
Stockwell MA, Sone N, Riley B. Colloid solutions in the critically ill: a randomized comparison of albumin and polygeline. 1: outcome and duration of stay in the intensive care unit. Anaesthesia 1992 Jan; 47(1): 3–6
Kirklin JK, Lell WA, Kouchoukos NT. Hydroxyethyl starch versus albumin for colloid infusion following cardiopulmonary bypass in patients undergoing myocardial revascularization. Ann Thorac Surg 1984 Jan; 37(1): 40–6
Boldt J, Knothe C, Schindler E, et al. Volume replacement with hydroxyethyl starch solution in children. Br J Anaesth 1993 Jun; 70(6): 661–5
Shatney CH, Deepika K, Militello PR, et al. Efficacy of hetastarch in the resuscitation of patients with multisystem trauma and shock. Arch Surg 1983 Jul; 118(7): 804–9
Vogt NH, Bothner U, Lerch G, et al. Large-dose administration of 6% hydroxyethyl starch 200/0.5 for total hip arthroplasty: plasma homeostasis, hemostasis, and renal function compared to use of 5% human albumin. Anesth Analg 1996 Aug; 83(2): 262–8
Marcus MAE, Vertommen JD, Aken HV. Hydroxyethyl starch versus lactated Ringer’s solution in the chronic maternal-fetal sheep preparation: a pharmacodynamic and pharmacokinetic study. Anesth Analg 1995 May; 80(5): 949–54
Dawidson IJA, Willms CD, Sandor ZF, et al. Ringer’s lactate with or without 3% dextran as volume expanders during abdominal aortic surgery. Crit Care Med 1991 Jan; 19(1): 36–42
So KW, Fok TF, Wong WW, et al. Randomized controlled trial of colloid or crystalloid in hypertensive preterm infants. Arch Dis Child 1997; 76: F43–6
Guha SC, Kinsky MP, Button B, et al. Burn resuscitation: crystalloid versus colloid versus hypertonic saline hyperoncotic colloid in sheep. Crit Care Med 1996 Nov; 24(11): 1849–57
Mortelmans YJ, Vermaut G, Verbruggen AM, et al. Effects of 6% hydroxyethyl starch and 3% modified fluid gelatin in intravascular volume and coagulation during intraoperative hemodilution. Anesth Analg 1995 Dec; 81(6): 1235–42
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Roberts, J.S., Bratton, S.L. Colloid Volume Expanders. Drugs 55, 621–630 (1998). https://doi.org/10.2165/00003495-199855050-00002
Published:
Issue Date:
DOI: https://doi.org/10.2165/00003495-199855050-00002