Twisting and ignoring facts on hydroxyethyl starch is not very helpful

Large randomized trials on critically ill patients have related the use of hydroxyethyl starch (HES) to negative outcomes. In a recent comment we explained in detail why, from our point of view, transferring the results of VISEP, 6S and CHEST into daily ICU practice is as difficult as their extrapolation to perioperative treatment. Haase, Müller and Perner lately challenged this analysis. However, after having carefully read their letter to the editor we are happy to demonstrate that all points we made were absolutely correct. We agree with Haase et al. that a debate on HES safety is important, but has to be based on facts. The difference might be that we like to thoroughly discuss all of them, including the main one: VISEP, 6S and CHEST do not capture the initial stabilization of their hemodynamically instable patients. The vast majority, including those patients later assigned to the "crystalloid" groups, had been stabilized with colloids before study onset. This is not a big problem, but has to be discussed carefully and honestly to prevent the data from being misinterpreted by users and official authorities.