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CONTRA: Hydroxyethyl starch solutions are unsafe in critically ill patients

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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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Acknowledgments

No funding was obtained in support of this analysis. The authors have in the past received unrestricted funding from B. Braun, Melsungen, for the conduct of the VISEP study.

Conflict of interest statement

The authors report no current conflict of interest.

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Authors and Affiliations

  1. Department of Anaesthesiology and Intensive Care Medicine, Friedrich Schiller University, Erlanger Allee 101, 07747, Jena, Germany

    Christiane Hartog & Konrad Reinhart

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  1. Christiane Hartog
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  2. Konrad Reinhart
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Corresponding author

Correspondence to Konrad Reinhart.

Additional information

C. Hartog and K. Reinhart contributed equally to this work.

The article arguing for this proposition is available at: doi:10.1007/s00134-009-1520-6.

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Hartog, C., Reinhart, K. CONTRA: Hydroxyethyl starch solutions are unsafe in critically ill patients. Intensive Care Med 35, 1337–1342 (2009). https://doi.org/10.1007/s00134-009-1521-5

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  • DOI: https://doi.org/10.1007/s00134-009-1521-5

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