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Why hydroxyethyl starch solutions should NOT be banned from the operating room
Stefan De Hert1, Luc De Baerdemaeker
1stefan.dehert@ugent.be.
Anaesthesiology Intensive Therapy
|November 30, 2014
Summary
Hydroxyethyl starches (HES) remain valuable for perioperative fluid therapy when used appropriately. Methodological flaws in key studies do not support a complete ban on HES solutions for critically ill patients.
Area of Science:
- Anesthesiology
- Intensive Care Medicine
- Pharmacology
Background:
- Perioperative fluid therapy is crucial for managing critically ill patients.
- Hydroxyethyl starches (HES) are commonly used fluid solutions.
- Recent studies have raised concerns regarding HES safety.
Purpose of the Study:
- To review current understanding of perioperative fluid therapy physiology.
- To analyze the safety of HES solutions in critically ill patients.
- To re-evaluate the evidence prompting restrictions on HES use.
Main Methods:
- Systematic review of physiological insights in fluid therapy.
- Critical analysis of major clinical trials on HES safety.
- Evaluation of methodological quality in cited studies.
Main Results:
- Identified significant methodological limitations in key studies questioning HES safety.
- Found that HES solutions can be safely used within specific indications and recommended doses.
- Highlighted issues in study designs that led to regulatory restrictions.
Conclusions:
- The evidence does not support a complete ban on hydroxyethyl starches.
- HES solutions maintain a role in perioperative fluid management when indicated.
- Proper patient selection and dosage are essential for safe HES administration.
