■ Dextrans
■ Highly branched polysaccharides
■ Various formulations available
■ May interfere with hemostasis
■ Maximum dosage 20 mL/kg
■ Gelatins
■ Modified derivatives of bovine collagen
■ Various formulations available
■ Dilutional coagulopathy seen with higher volumes
■ Polystarches
■ Pentastarch and hexastarch most commonly used
■ Limited usefulness secondary to dilutional coagulopathy and possible
platelet inhibition
CLINICALINDICATIONS
■ Colloid solutions are never indicated as primary therapy for volume
resuscitation.
■ Possible negative impact on mortality for sepsis
■ Indicated for the treatment of spontaneous bacterial peritonitis and for
patients receiving large volume paracentesis
Blood Products
PACKEDREDBLOODCELLS(PRBCS)
Packed red blood cells have the additional benefit of augmenting O 2 transport.
Typically, begin by administering 2 units in adults or 15 mL/kg in children.
One unit of PRBCs is sufficient to raise Hgb by 1.0 g/dL.
RBC storage:
■ All products are packaged with anticoagulant preservative of citrate, phos-
phate, dextrose, and adenine.
■ Storage results in RBC changes.
■ ↓Levels of 2,3 DPG
■ Leakage of potassium
■ Spherical and rigid shape of cells
AVAILABLEPRODUCTS
■ Typed and cross-matched is preferred over type-specific, which is preferred
over O negative.
■ Women of child-bearing age or younger should not receive Rh-positive
blood until testing indicates they are Rh-positive.
■ Adult unit = 350 mL, HCT 57%
■ Pediatric unit = 60 mL, HCT 72%
■ Leukocyte-poor PRBCs will:
■ Prevent febrile nonhemolytic reactions
■ Prevent sensitization to patients eligible for bone marrow transplant
■ Prevent platelet alloimmunization in some cases
■ Minimize risk of virus (CMV, HIV) transmission
CLINICALINDICATIONS
■ Any cause of acute hemorrhage that does not respond to crystalloid
■ Known ongoing hemorrhage
■ Symptomatic anemia (ischemia, organ dysfunction, hypoxia)
RESUSCITATION