is a synthetic derivative of starch
, which has five hydroxyethyl groups.
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.
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 and
- use of normal saline may lead to pulmonary edema, particularly in older patients.
Normal saline versus pentastarch
Pentastarch in the emergency
setting is not well studied and its use not of proven benefit. One small study, comparing normal saline and pentastarch, failed to show any significant survival advantage; however, significantly less volume was required for resuscitation in the pentastarch group.
A study is currently being done to compare normal saline
with pentastarch following cardiac surgery
Pentastarch is more expensive than normal saline, but less expensive than albumin