Remplissage vasculaire au bloc opératoire avec ou sans HEA (podcast)

Among hydroxyethylstarches (HES), only tetrastarches 130/0.4 are commercially available in France. Recent reports highlight the critical role of the glycocalyx in physiological vascular permeability and pathophysiological type 2 capillary leak. These reports have changed the pharmacological approach of crystalloids and colloids use. The European Medicines Agency and the French authorities have recently limited the clinical use of HES to perioperative hypovolemia, hemorrhage and trauma. Goal-directed therapy includes the baseline fluid support that should be conducted on a restrictive way by using mainly crystalloids, and on the other hand, the dynamic evaluation of fluid responsiveness based on continuous stroke volume monitoring in high-risk surgical patients to early compensate perioperative blood losses mainly by using colloids.