Volume therapy: is there a colloïdeal solution?

The clinical effect of a starch solution derives from a balance of all the characteristics mentioned above (concentration, Mw, polydispersity, MS, DS and C2/C6 ratio). Table 5 describes how these characteristics determine the volume effect. Concentration determines the volume effect. The Mw, the MS, the DS and the C2/C6 ratio determine the duration of the volume effect. A product with a high concentration, but with a low molecular weight, a low molar substitution, a low degree of substitution and a low C2/C6 ratio will have a potent, yet short-acting effect. The characteristics of a starch solution can determine the strength and speed of the initial volume effect. A 6% 130.000 Da starch contains more particles than a 6% 200.000 Da starch. Thus the initial volume effect of the lower Mw solution is greater.180 A 6% HES 70/0.5 solution contains even more particles than 6% HES 130/0.4, but has a lower initial volume effect, because a large proportion of smaller starch molecules will be rapidly eliminated by the kidneys, reducing efficacy and preserving oxygen supply less well compared to HES 130.180 Over time, the search for the ideal starch solution has lead to the development of different HES products, all with their own unique profile. Different starches are best suited to different indications: see Table 6. The different starches also have different licensed dose maxima. Long-acting starch (HES 200/0.62) has a maximum dose of 20 ml/kg/day (about 1500 ml for a patient of 70 kilos). HES 130/0.4 has a maximum dose of 50 ml/kg/day (about 3500 ml for a patient of 70 kilos). Practically, short-acting corn starch products (like HES 130/0.4) can be used (almost) whenever needed (SPC HES 130/0.4 (Voluven®). 25,40,41,102,131,154,199. A table is presented