Haemostasis and volume replacement solutions

Findings concerning the effects of colloids on haemostasis in critically il l patients are scarce, The results of studies in volunteers, after perioper ative haemodilution as well as in-vitro results suggest that all colloids u sed for fluid resuscitation influence haemostasis by dilution of blood coag ulation factors and blood cells. Dextran and gelatine solutions exert speci fic effects on thrombocyte function and quality of clot formation respectiv ely, Their use in critical illness remains poorly documented, According to the clinical and laboratory data available, hydroxyethyl starch (HES) solut ions with a mean molecular weight <200.000, a degree of substitution < 0.6, and a C2/C6 hydroxyethylation ratio > 6 exert little effects on haemostasi s and can be used safely up to a dose of 2 g/kg b.w./d.