Fluid therapy colloids

Has the goal arterial blood pressure been achieved If not, give additional fluid therapy hourly blending crystalloids and isooncotic colloids based on inadequate blood pressure response. 

The use of colloids has recently been advocated for the resuscitation of hypovolemic horses and for the treatment of severe hypoproteinemia (McFarlane 1999). Colloids have two advantages over crystalloids that makes them attractive for fluid therapy. Firstly, because of their persistence in the circulation, a three to six times lower volume of a colloid solution is required to produce the same resuscitative effect as a crystalloid solution (Rackow et al 1987). This is particularly useful in acute resuscitation of severely dehydrated horses or in the field where large amounts of crystalloids may be difficult to transport. Secondly, the administration of colloids can increase colloidal oncotic pressure, in contrast to the administration of large volumes of crystalloids, which decreases the colloidal oncotic pressure (Jones et al 1997,2001). 

Most clinicians agree that crystalloids should be the initial therapy of circulatory insufficiency. Crystalloids are preferred over colloids as initial therapy for burn patients because they are less likely to cause interstitial fluid accumulation. If volume resuscitation is suboptimal following several liters of crystalloid, colloids should be considered. Some patients may require blood products to assure maintenance of 02-carrying capacity, as well as clotting factors and platelets for blood hemostasis. 

In addition to spironolactone, ascites can be managed by paracentesis. That is the removal ( tapping ) of ascitic fluid from the peritoneal cavity under aseptic conditions. A colloid (human albumin solution (20%)) is infused (40 mL (8 g of albumin) per litre of ascites drained) intravenously during paracentesis, in order to prevent intravascular volume depletion and the onset of renal failure. Following paracentesis, ascites recurs in the majority (93%) if diuretic therapy is not reinstituted, but recurs in only 18% of patients treated with... 

Abdominal paracentesis is useful particularly when ascites is tense rapid drainage of 5 litres leads to prompt relief of discomfort and improves circulatory dynamics. Provided renal function is not compromised, extensive paracentesis is safe and can be used as an adjunct to diuretic therapy to shorten hospital stay. When more than 5 litres are drained it is customary to infuse colloid or albumin (6-8 g per litre of fluid removed) to prevent hypovolaemia. 

Therapeutic plasma exchange (TPE), or plasmapheresis (PP), is an extracorporeal therapy most frequently used in the treatment of hematologic disorders, and autoimmune neuropathies and vasculitides [37]. This modality occasionally is also employed in the treatment of poisoning. The apparatus involves central venous access and a blood circuit between the patient and a pheresis machine. Cytopheresis by centrifugation or filtration then separates the formed elements of blood from plasma. The cells are returned to the patient while the plasma (with the poison) is discarded. Fluid volume is typically replaced with crystalloid, colloid, or fresh frozen plasma (FFP) if clotting factor repletion is necessary. 

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