Modified haemoglobins and perfluorocarbons

Why Perfluorocarbon nanoparticles encounter bottlenecks in clinical translation despite promising oxygen carriers?

Artificial Oxygen Carriers (AOCs) have emerged as ground-breaking biomedical solutions, showcasing tremendous potential for enhancing human health and saving lives. Perfluorocarbon (PFC)-based AOCs, in particular, have garnered significant interest among researchers, leading to numerous clinical trials since the 1980 s. However, despite decades of exploration, the success rate has remained notably limited. This comprehensive review article delves into the landscape of clinical trials involving PFC compounds, shedding light on the challenges and factors contributing to the lack of clinical success with PFC nanoparticles till date. By scrutinizing the existing trials, the article aims to uncover the underlying issues like pharmacological side effects of the PFC and the nanomaterials used for the designing, complex formulation strategy and poor clinical trial designs of the formulation. More over each generation of the PFC formulation were discussed with details for their failure in the clinical trials limitations that block the path of PFC-based AOCs' full potential. Furthermore, the review emphasizes a forward-looking approach by outlining the future pathways and strategies essential for achieving success in clinical trials. AOCs require advanced yet biocompatible single-componentformulations. The new trend might be a novel drug delivery technique, like gel emulsion or reverse PFC emulsion with fluoro surfactants. Most importantly, well-planned clinical trials may end in a success story.

Which fluid to give?

Crystalloids are generally accepted, as the initial fluid of choice during trauma patient resuscitation but the pragmatic approach is to give a combination of both crystalloid and colloid. Plasmalyte 148 has advantages over both saline and lactated Ringer’s. Medium-or low-molecular weight hydroxyethyl starch may be the colloid of choice. In the future, haemoglobin-based oxygen carriers are likely to play a prominent role in trauma resuscitation.

Fluid resuscitation for the trauma patient

Attempts at prehospital fluid replacement should not delay the patient's transfer to hospital. Before bleeding has been stopped, a strategy of controlled fluid resuscitation should be adopted. Thus, the risk of organ ischaemia is balanced against the possibility of provoking more bleeding with fluids. Once haemorrhage is controlled, normovolaemia should be restored and fluid resuscitation targeted against conventional endpoints, the base deficit, and plasma lactate. Initially, the precise fluid used is probably not important, as long as an appropriate volume is given; anaemia is much better tolerated than hypovolaemia. Colloids vary substantially in their pharmacology and pharmacokinetics and the experimental findings from one cannot be extrapolated reliably to another. We still lack reliable data to prove that any of the colloids reduce mortality in trauma patients. In the presence of SIRS, hydroxyethyl starch may reduce capillary leak. Hypertonic saline solutions may have some benefit in patients with head injuries although this has yet to be proven beyond doubt. It is likely that one or more of the haemoglobin-based oxygen carriers currently under development will prove to be valuable in the treatment of the trauma patient.