title: Fluid replacement with hydroxyethyl starch in critical care--a reassessment.
abstract: BACKGROUND
  Hydroxyethyl starch (HES) is used for fluid replacement in millions of patients around the world every year, yet it has been found to have adverse effects that have a negative impact on patient survival. Recent clinical trials with a modern HES solution (HES 130) and meta-analyses now enable a reassessment of its risks and benefits.
  
  
  METHODS
  On the basis of a selective literature search focusing on reports of the use of HES 130/0.4 and HES 130/0.42 in sepsis, trauma, and intensive care medicine, data from randomized controlled trials (RCTs) are presented, and up-to-date meta-analyses and reviews are discussed. Moreover, the authors conducted an independent meta-analysis of HES 130 in comparison to crystalloids or albumin in intensive care medicine, sepsis, and trauma.
  
  
  RESULTS
  Seven RCTs were evaluated, involving a total of 7838 patients treated for sepsis or trauma, or in intensive care. HES 130 was associated with a higher cumulative risk of death (relative risk [RR] 1.10, 95% confidence interval [CI] 1.01-1.20), more frequent need for a renal replacement procedure (RR 1.26, 95% CI 1.08-1.46), and more frequent need for blood transfusion (RR 1.22, 95% CI 1.08-1.37). There was no patient-relevant benefit. Four recent meta-analyses of data from a total of more than 10 000 patients confirmed these concerns about the safety of HES in general and, in particular, of low-molecular-weight HES 130 for patients in intensive care. The safety of 6% HES 130 in the immediate perioperative period has not been adequately demonstrated.
  
  
  CONCLUSIONS
  Because of safety concerns, fluid replacement with HES in critically ill patients cannot be recommended. Evidence for its superior efficacy, safety and cost effectiveness in preoperative use is also lacking.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine and Integrated Research and Treatment Center for Sepsis Control and Care, Jena University Hospital, Germany.
authors.forename: Christiane S
authors.initials: CS
authors.lastname: Hartog
authors.forename: Tobias
authors.initials: T
authors.lastname: Welte
authors.forename: Peter
authors.initials: P
authors.lastname: Schlattmann
authors.forename: Konrad
authors.initials: K
authors.lastname: Reinhart
mesh_terms: D000418:Albumins / Q000627:therapeutic use; D003422:Critical Care / Q000706:statistics & numerical data; D016638:Critical Illness / Q000401:mortality* / Q000628:therapy*; D000077324:Crystalloid Solutions; D019317:Evidence-Based Medicine; D005440:Fluid Therapy / Q000401:mortality*; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use; D007552:Isotonic Solutions / Q000627:therapeutic use; D010952:Plasma Substitutes / Q000627:therapeutic use; D012307:Risk Factors; D018805:Sepsis / Q000401:mortality* / Q000628:therapy*; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000401:mortality* / Q000628:therapy*
chemical_list: D000418:Albumins; D000077324:Crystalloid Solutions; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes