CONTRA: Hydroxyethyl starch solutions are unsafe in critically ill patients.
OBJECTIVE
To describe the risk-benefit profile of hydroxyethyl starch (HES).


METHODS
Narrative review.


RESULTS
(1) EFFICACY: no single clinical study or systemic review has shown that administration of any HES solution confers a clinically relevant benefit compared to crystalloids in critically ill patients or surgical patients in need of volume replacement. Contrary to beliefs expecting a ratio of 4:1 or more for crystalloid to colloid volume need, recent studies of goal-directed resuscitation observed much lower ratios of between 1 and 1.6. (2) SAFETY: HES administration is associated with coagulopathy, nephrotoxicity, pruritus and increased long-term mortality. Clinical studies claiming that modern HES 130/0.4 is safe have serious methodological drawbacks and do not adequately address the safety concerns.


CONCLUSIONS
Given the complete lack of superiority in clinical utility studies and the wide spectrum of severe side effects, the use of HES in the ICU should be stopped. The belief that four times as much crystalloid as colloid fluid volume is needed for successful resuscitation is being seriously questioned.
Hartog
Christiane
C
Department of Anaesthesiology and Intensive Care Medicine, Friedrich Schiller University, Erlanger Allee 101, 07747 Jena, Germany.
Reinhart
Konrad
K
D003102:Colloids / Q000009:adverse effects / Q000627:therapeutic use; D000075202:Contraindications; D016638:Critical Illness; D000077324:Crystalloid Solutions; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects* / Q000627:therapeutic use; D007552:Isotonic Solutions / Q000008:administration & dosage / Q000627:therapeutic use; D010952:Plasma Substitutes / Q000009:adverse effects* / Q000627:therapeutic use
D003102:Colloids; D000077324:Crystalloid Solutions; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes