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Intensive Care Medicine

Published in:

01-08-2009 | Special Article

CONTRA: Hydroxyethyl starch solutions are unsafe in critically ill patients

Authors: Christiane Hartog, Konrad Reinhart

Published in: Intensive Care Medicine | Issue 8/2009

Abstract

Purpose

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.

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Title: CONTRA: Hydroxyethyl starch solutions are unsafe in critically ill patients
Authors: Christiane Hartog
Konrad Reinhart
Publication date: 01-08-2009
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 8/2009
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-009-1521-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

CONTRA: Hydroxyethyl starch solutions are unsafe in critically ill patients

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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