Current Trends in Volume Replacement Therapy and the Use of Synthetic Colloids in Small Animals-An Internet-Based Survey (2016)

Abstract

The use of synthetic colloids (SCs), particularly hydroxyethyl starch (HES), in people has changed in recent years following new evidence raising concerns about their efficacy and safety. Although fluid therapy guidelines for small animals are often extrapolated from human medicine, little information exists on current practice in veterinary medicine. The objective of the present study was to investigate current fluid selection, use of plasma volume expanders including SCs, and recent changes in their use in small animal practice. An Internet-based survey was conducted, inviting veterinarians to report their practices in fluid resuscitation and colloid osmotic pressure support, their choice of SC, and perceived adverse effects and contraindications associated with SC use. There were 1,134 respondents from 42 countries, including 46% general practitioners and 38% diplomates. Isotonic crystalloids, HES, and hypertonic saline were chosen by most respondents for fluid resuscitation, and HES by 75% of respondents for colloid osmotic support. Dextran and gelatin were used by some European respondents. Human serum albumin was used more than canine albumin but 45% of respondents, particularly those from Australia and New Zealand, used no albumin product. The majority (70%) of respondents changed their practice regarding SCs in recent years (mostly by limiting their use), largely due to safety concerns. However, only 27% of respondents worked in an institution that had a general policy on SC use. Impaired renal function, coagulopathy, and hypertension were most often considered contraindications; impaired coagulation tests and increased respiratory rate were the most frequently perceived adverse effects. The use of HES remains widespread practice in small animals, regardless of geographic location. Nevertheless, awareness of safety issues and restrictions on the use of SCs imposed in human medicine seems to have prompted a decrease in use of SCs by veterinarians. Given the paucity of evidence regarding efficacy and safety, and differences in cohorts between human and veterinary critical care patients, studies are needed to establish evidence-based guidelines specific for dogs and cats.

Keywords: dextran; fluid therapy; gelatin; hydroxyethyl starch; plasma expanders; synthetic colloids.

Figure 1

Frequency chart showing the geographic distribution of the 1,134 survey respondents. Countries represented by 30 or more respondents are shown separately within each geographic area.

Figure 2

Frequency chart showing the qualifications and case types seen by the 1,134 survey respondents.

Figure 3

Frequency chart showing the relative frequency with which the 1,134 survey respondents use intravenous solutions for fluid resuscitation. CRYS, crystalloids; HTS, hypertonic saline; HES, hydroxyethyl starch; DEX, dextran; GEL, gelatin; ALB, albumin.

Figure 4

Frequency chart showing the type of intravenous solutions used by the 1,134 survey respondents for fluid resuscitation in specific disease conditions. SIRS, systemic inflammatory response syndrome; GDV, gastric dilatation-volvulus; GI loss, gastrointestinal loss.

Figure 5

Frequency chart showing the relative frequency with which the 1,134 survey respondents use intravenous solutions for colloid osmotic support. HES, hydroxyethyl starch; GEL, gelatin; DEX, dextran; ALB, albumin.

Figure 6

Frequency chart showing the type of intravenous solutions used by the 1,134 survey respondents for colloid osmotic support in specific disease conditions. SIRS, systemic inflammatory response syndrome; PLE, protein-losing enteropathy; PLN, protein-losing nephropathy.

Figure 7

Frequency chart showing the primary synthetic colloid used by the 1,134 survey respondents from different geographic areas.

Figure 8

Frequency chart showing the relative importance of criteria reported as considerations in the selection of synthetic colloids by 1,024 survey respondents.

Figure 9

Frequency chart showing the relative importance of criteria used to guide the decision to use synthetic colloids as a constant rate infusion reported by 681 survey respondents.

Figure 10

Frequency chart showing the changes in synthetic colloid use over the past 5 years and/or because of new recommendations reported by survey respondents (650 hydroxyethyl starch users; 27 gelatin users; 11 dextran users).

Figure 11

Frequency chart showing incidence of adverse reactions noted by survey respondents since changing their use of synthetic colloids (654 hydroxyethyl starch users; 27 gelatin users; 12 dextran users).

Figure 12

Frequency chart showing relative and absolute contraindications for the use of hydroxyethyl starch perceived by 632 survey respondents.