title: Controversies in the use of hydroxyethyl starch solutions in small animal emergency and critical care.
abstract: OBJECTIVE
  To (1) review the development and medical applications of hydroxyethyl starch (HES) solutions with particular emphasis on its physiochemical properties; (2) critically appraise the available evidence in human and veterinary medicine, and (3) evaluate the potential risks and benefits associated with their use in critically ill small animals.
  
  
  METHODS
  Human and veterinary original research articles, scientific reviews, and textbook sources from 1950 to the present.
  
  
  RESULTS
  HES solutions have been used extensively in people for over 30 years and ever since its introduction there has been a great deal of debate over its safety and efficacy. Recently, results of seminal trials and meta-analyses showing increased risks related to kidney dysfunction and mortality in septic and critically ill patients, have led to the restriction of HES use in these patient populations by European regulatory authorities. Although the initial ban on the use of HES in Europe has been eased, proof regarding the benefits and safety profile of HES in trauma and surgical patient populations has been requested by these same European regulatory authorities.
  
  
  RESULTS
  The veterinary literature is limited mostly to experimental studies and clinical investigations with small populations of patients with short-term end points and there is insufficient evidence to generate recommendations.
  
  
  CONCLUSIONS
  Currently, there are no consensus recommendations regarding the use of HES in veterinary medicine. Veterinarians and institutions affected by the HES restrictions have had to critically reassess the risks and benefits related to HES usage based on the available information and sometimes adapt their procedures and policies based on their reassessment. Meanwhile, large, prospective, randomized veterinary studies evaluating HES use are needed to achieve relevant levels of evidence to enable formulation of specific veterinary guidelines.
authors: Department of Veterinary Clinical Medicine, Division of Small Animal Emergency and Critical Care, Vetsuisse Faculty, University of Bern, Bern, Switzerland.
authors: Katja N
authors: KN
authors: Adamik
authors: Ivayla D
authors: ID
authors: Yozova
authors: Nadine
authors: N
authors: Regenscheit
mesh_terms: D000818:Animals; D003422:Critical Care / Q000379:methods*; D004630:Emergencies / Q000662:veterinary*; D005060:Europe; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000008:administration & dosage* / Q000009:adverse effects; D010952:Plasma Substitutes / Q000008:administration & dosage* / Q000009:adverse effects; D011446:Prospective Studies; D014730:Veterinary Medicine
chemical_list: D006895:Hydroxyethyl Starch Derivatives; D010952:Plasma Substitutes
keywords: colloids; hypovolemia; safety; sepsis; side effects