Pentastarch

Choice of resuscitation fluid

The choice of fluid (normal saline vs. Ringer's lactate vs. pentaspan) is controversial.

Physiologically, fluid with pentaspan stays primarily in the intravascular space: blood plasma. This is different than normal saline, which shifts quickly into the rest of the extracellular compartment.

Advocates of pentaspan use believe that:

1. the primary deficit in fluid resuscitation is intravascular volume loss and
2. use of normal saline may lead to pulmonary edema, particularly in older patients.

Normal saline versus pentastarch

Casualty

Pentastarch in the emergency setting is not well studied and its use not of proven benefit. One small study that compared normal saline and pentastarch failed to show any significant survival advantage; however, significantly less volume was required for resuscitation in the pentastarch group.

Cardiac surgery

A study is currently being done to compare normal saline with pentastarch following cardiac surgery.

Cost

Pentastarch is more expensive than normal saline, but less expensive than albumin.

References

References

1. (1983). "Colloid and crystalloid fluid resuscitation". Acute Care.
2. (1998). "Use of pentastarch solution in the treatment of patients with hemorrhagic hypovolemia: randomized phase II study in the emergency room". World Journal of Surgery.
3. Double Blind Randomized Trial of Saline vs Pentaspan for Resuscitation After Cardiac Surgery. ClinicalTrials.gov. URL: [http://clinicaltrials.gov/show/NCT00337805 http://clinicaltrials.gov/show/NCT00337805]. Accessed on: July 21, 2007.