Hydroxyethyl Starch

To evaluate the clinical impact of optimizing stroke volume (SV) through fluid administration as part of goal-directed hemodynamic therapy (GDHT) in adult patients undergoing elective major abdominal surgery.

This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and was registered in the PROSPERO database in January 2024. The intervention was defined as intraoperative GDHT based on the optimization or maximization of SV through fluid challenges, or by using dynamic indices of fluid responsiveness, including stroke volume variation, pulse pressure variation, and plethysmography variation index compared to usual fluid management. The primary outcome was postoperative complications. Secondary outcome variables included postoperative acute kidney injury (AKI), length of stay (LOS), intraoperative fluid administration, and 30-day mortality.

A total of 29 randomized controlled trials (RCTs) met the inclusion criteria. There were no significant differences in the incidence of postoperative complications (RR 0.89; 95% CI, 0.78-1.00), postoperative AKI (OR 0.97; (95% IC, 0.55-1.70), and mortality (OR 0.80; 95% CI, 0.50-1.29). GDHT was associated with a reduced LOS compared to usual care (SMD: -0.17 [-0.32; -0.03]). The subgroup in which hydroxyethyl starch was used for hemodynamic optimization was associated with fewer complications (RR 0.79; 95% CI, 0.65-0.94), whereas the subgroup of patients in whom crystalloids were used was associated with an increased risk of postoperative complications (RR 1.08; 95% CI, 1.04-1.12).

In adults undergoing major surgery, goal-directed hemodynamic therapy focused on fluid-based stroke volume optimization did not reduce postoperative morbidity and mortality.

Eliminating persistent inflammation and choosing dressings that provide the best healing environment is key to promoting wound healing. Dynamic and reversible hydrogels have attracted much attention because of their capacity to adapt to irregular wound surfaces. Herein, oxidized hydroxyethyl starch (OHES) and hyaluronic acid (HA-ADH) were crosslinked via the dynamic acylhydrazone bond to form an anti-inflammatory function hydrogel (HA-ADH/OHES@XT) that could release xanthatin (XT) slowly. The HA-ADH/OHES hydrogels showed an appropriate gelation time, notable water-retaining capacity, self-healing, suitable biodegradability, and good biocompatibility for wound healing applications. In vivo experiments demonstrated that HA-ADH/OHES@XT hydrogels promoted tissue regeneration and wound healing at a rate of approximately 89.1 % on day 20 by reducing inflammation, increasing collagen deposition, and promoting re-epithelialization, indicating their great potential as a wound dressing.