title: Hydroxyethyl starch for resuscitation.
abstract: OBJECTIVE
  Resuscitation with hydroxyethyl starch (HES) is controversial. In this review, we will present the current evidence for the use of HES solutions including data from recent high-quality randomized clinical trials.
  
  
  RESULTS
  Meta-analyses of HES vs. control fluids show clear signals of harm including adverse effects on kidney and haemostatic function, and trends towards increased mortality. These results are mainly based on recent large randomized clinical trials comparing tetrastarch (HES 130/0.4 and HES 130/0.42) vs. crystalloid in patients in the ICU. Trials in trauma and surgical patients cannot adequately assess safety issues and do not show clear benefit with the use of HES. There is currently no firm evidence that tetrastarch has better safety profile than the former HES solutions.
  
  
  CONCLUSIONS
  There is no evidence for an overall beneficial effect of HES in any subgroup of critically ill patients, but there are clear signs of harm. As safer alternatives exist, we recommend that HES is no longer used in critically ill patients.
authors.affiliation: Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
authors.forename: Nicolai
authors.initials: N
authors.lastname: Haase
authors.forename: Anders
authors.initials: A
authors.lastname: Perner
mesh_terms: D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D005440:Fluid Therapy / Q000379:methods* / Q000401:mortality; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage* / Q000009:adverse effects; D010952:Plasma Substitutes / Q000008:administration & dosage* / Q000009:adverse effects; D016032:Randomized Controlled Trials as Topic; D015532:Rehydration Solutions / Q000627:therapeutic use*; D012151:Resuscitation / Q000379:methods* / Q000401:mortality; D018805:Sepsis / Q000628:therapy; D014947:Wounds and Injuries / Q000209:etiology
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes; D015532:Rehydration Solutions