Synopsis

Source of validity: Scientific
Rating (out of 5): 3

Dextran is a high-molecular-weight polysaccharide used as a plasma volume expander in cases of hypovolemic shock, particularly when blood loss leads to decreased circulating volume and impaired tissue perfusion. The rationale for its use is based on its ability to increase intravascular oncotic pressure, thereby drawing fluid into the vascular compartment and helping to restore blood pressure and organ perfusion. Clinical studies from the mid-20th century demonstrated that dextrans (notably Dextran 40 and Dextran 70) were effective at expanding plasma volume and improving hemodynamic stability in shock patients. However, more recent research and systematic reviews have questioned the routine use of dextran due to potential adverse effects such as coagulopathy, anaphylactoid reactions, and interference with blood cross-matching.

While dextran was once widely used as a first-line colloid in shock management, especially in trauma and surgical settings, its use has declined in favor of safer and more effective alternatives such as crystalloids and albumin. Current guidelines generally do not recommend dextran as the preferred resuscitation fluid due to its risk profile and lack of clear superiority in improving survival outcomes. Thus, although there is scientific evidence supporting its mechanism and historical use, modern evidence does not strongly favor dextran over other options, resulting in a moderate evidence rating.

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