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Fixed Volume or Fixed Pressure: A Murine Model of Hemorrhagic Shock

Fixed Volume or Fixed Pressure: A Murine Model of Hemorrhagic Shock

Published on: June 6, 2011

Hydroxyethyl starch for resuscitation.

Nicolai Haase¹, Anders Perner

¹Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.

Current Opinion in Critical Care

|June 8, 2013

Summary

This summary is machine-generated.

Hydroxyethyl starch (HES) resuscitation is controversial. Evidence shows HES solutions, including tetrastarch, pose risks to kidney and hemostatic function, with no clear benefits, leading to recommendations against their use in critically ill patients.

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Area of Science:

Critical Care Medicine
Pharmacology
Nephrology

Background:

Hydroxyethyl starch (HES) solutions are widely used for fluid resuscitation.
The safety and efficacy of HES, particularly newer generations like tetrastarch, remain subjects of debate.
Concerns exist regarding potential adverse effects on kidney and hemostatic function.

Purpose of the Study:

To review current evidence on the use of HES solutions for resuscitation.
To evaluate data from recent high-quality randomized clinical trials.
To assess the safety and efficacy of HES compared to control fluids and crystalloids.

Main Methods:

Systematic review and meta-analysis of randomized clinical trials.
Comparison of HES (including tetrastarch) versus control fluids (crystalloids).
Analysis of data from critically ill, trauma, and surgical patient populations.

Main Results:

Meta-analyses indicate HES use is associated with clear signals of harm.
Adverse effects include impaired kidney and hemostatic function, with trends toward increased mortality.
No clear benefits were demonstrated in trauma or surgical patients, and tetrastarch shows no improved safety profile over older HES solutions.

Conclusions:

There is no evidence of overall benefit from HES in any critically ill patient subgroup.
Significant safety concerns, including kidney and hemostatic dysfunction, are associated with HES use.
Given the availability of safer alternatives, HES is not recommended for critically ill patients.