Pentastarch

Pentastarch is a subgroup of hydroxyethyl starch, with five hydroxyethyl groups out of each 11 hydroxyls, giving it approximately 50% hydroxyethylation. This compares with tetrastarch at 40% and hetastarch at 70% hydroxyethylation, respectively.

It is sold under the name Pentaspan and used for fluid resuscitation. It is considered a plasma expander because it remains primarily intravascular after infusion.

Choice of resuscitation fluid

The choice of fluid (normal saline vs. Ringer's lactate vs. pentaspan) is controversial.^[1]

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:

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

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.^[2]

Cardiac surgery

A study is currently being done to compare normal saline with pentastarch following cardiac surgery.^[3]

Cost

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

References

^ ^a ^b ^c Falk JL, Rackow EC, Weil MH (1983). "Colloid and crystalloid fluid resuscitation". Acute Care. 10 (2): 59–94. PMID 6085668.
^ Younes RN, Yin KC, Amino CJ, Itinoshe M, Rocha e Silva M, Birolini D (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. 22 (1): 2–5. doi:10.1007/s002689900340. PMID 9465753. S2CID 37628065.
^ Double Blind Randomized Trial of Saline vs Pentaspan for Resuscitation After Cardiac Surgery. ClinicalTrials.gov. URL: http://clinicaltrials.gov/show/NCT00337805. Accessed on: July 21, 2007.

External links

Pentaspan monograph - rxmed.com.
Structure of Pentaspan.

[falk-1] Falk JL, Rackow EC, Weil MH (1983). "Colloid and crystalloid fluid resuscitation". Acute Care. 10 (2): 59–94. PMID 6085668.

[2] Younes RN, Yin KC, Amino CJ, Itinoshe M, Rocha e Silva M, Birolini D (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. 22 (1): 2–5. doi:10.1007/s002689900340. PMID 9465753. S2CID 37628065.

[3] Double Blind Randomized Trial of Saline vs Pentaspan for Resuscitation After Cardiac Surgery. ClinicalTrials.gov. URL: http://clinicaltrials.gov/show/NCT00337805. Accessed on: July 21, 2007.

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