CONTRA: Hydroxyethyl starch solutions are unsafe in critically ill patients

@article{Hartog2009CONTRAHS,
  title={CONTRA: Hydroxyethyl starch solutions are unsafe in critically ill patients},
  author={Christiane S. Hartog and Konrad Reinhart},
  journal={Intensive Care Medicine},
  year={2009},
  volume={35},
  pages={1337-1342}
}
PurposeTo describe the risk–benefit profile of hydroxyethyl starch (HES).MethodsNarrative 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… 
Hydroxyethyl starches: Plus ça change, plus c'est la même chose.
TLDR
Not 1 of the 140 studies cited in this extensive review nor any previous meta-analysis could demonstrate the superiority of synthetic colloids or HES over crystalloids as a volume replacement, or gelatins, which all are substances known to have adverse effects on renal function and coagulation.
Effects of Fluid Treatment With Hydroxyethyl Starch on Renal Function in Patients With Aneurysmal Subarachnoid Hemorrhage
TLDR
The results suggest that the administration of HES 6% 130/0.4 is safe in SAH patients without preexisting renal insufficiency, and the first days after SAH seem to be a vulnerable phase in which a variety of interventions are performed, including contrast-enhanced neuroradiologic procedures.
Hydroxyethyl starches: what do we still know?
The choice of fluids for intravascular volume replacement has been debated for decades. As early as 1919, Benjamin Moore eloquently commented on the relative merits of colloids and crystalloids in
Safety and efficacy of peri-operative administration of hydroxyethyl starch in children undergoing surgery: A systematic review and meta-analysis
TLDR
Intravascular volume expansion with low molecular weight 6% HES did not appear to modify renal function, blood loss or transfusion when administered to children during the peri-operative period, however, given the lack of statistical power and the very low quality of evidence, more high-quality RCTs are needed to explore these outcomes.
Low molecular weight pentastarch is more effective than crystalloid solution in goal-directed fluid management in patients undergoing major gastrointestinal surgery
TLDR
HES 70/0.5 exerted larger volume effects than did crystalloid under nonspecific conditions, however, similar volume effects were observed during volume loss and extensive sympathetic blockade.
Crystalloid or Colloid Fluids: A Matter of Volumes?
TLDR
In the Saline versus Albumin Fluid Evaluation (SAFE) study, for instance, albumin 4 % versus saline loading may have improved survival of septic patients but not of those with traumatic brain injury.
Effect of hydroxyethyl starch 130/0.4 on blood loss and coagulation in patients with recent exposure to dual antiplatelet therapy undergoing off-pump coronary artery bypass graft surgery.
TLDR
A moderate dose of 6% HES 130/0.4 did not increase the perioperative blood loss compared to crystalloid in patients with recent exposure to DAPT undergoing OPCAB and caused a similar degree and duration of coagulation impairment as observed when only crystalloid was given.
Intraoperative Hydroxyethyl Starch 70/0.5 Is Not Related to Acute Kidney Injury in Surgical Patients: Retrospective Cohort Study
TLDR
In this uncontrolled retrospective chart review, intraoperative 6% HES 70/0.5 in a low dose was not related to postoperative AKI in patients with major intraoperative blood loss and Randomized controlled trials are warranted to further evaluate the safety and efficacy of low-molecular-weight HES.
The effects of hydroxyethyl starch on cultured renal epithelial cells.
TLDR
An in vitro study investigating the possible pathophysiologic mechanisms of HES-related toxicity are of growing interest to clinicians and highlights the need for well-designed experimental and clinical studies with relevant end points on the subject.
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TLDR
Hematological cancer, the presence of sepsis, cardiovascular failure, and baseline renal function as assessed by the SOFA score were independent risk factors for the subsequent need for RRT in the ICU.
The effects of hydroxyethyl starch solution in critically ill patients.
TLDR
Hydroxyethyl starch 6% ws 130,000 dalton ms 0.4 (Voluven) is an effective fluid for resuscitation of hypovolemic patients and represent an attractive alternative to albumin.
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TLDR
High-dose HH with HES or NaCl was generally safe and well tolerated, safety profiles were similar for the two treatment groups, and there was a nonsignificant trend towards a better functional outcome with Hes therapy.
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It is concluded that HES 130/0.4 can safely be used in critically ill head trauma patients over several days at doses of up to 70 mL · kg−1 · d−1.
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TLDR
It is important to inquire about prior HES exposure in the diagnostic evaluation of pruritus sine materia, and well‐designed clinical outcome studies are needed to assess more fully the incidence, dose dependency and mechanisms ofPruritus with particular HES solutions.
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TLDR
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RETRACTED ARTICLE: Volume replacement with HES 130/0.4 may reduce the inflammatory response in patients undergoing major abdominal surgery
TLDR
Intravascular volume replacement with HES 130/0.4 may reduce the inflammatory response in patients undergoing major surgery compared to a crystalloid-based volume therapy, and it is hypothesized that this is most likely due to an improved microcirculation with reduced endothelial activation and less endothelial damage.
The Effects of Hydroxyethyl Starch 130/0.4 (6%) on Blood Loss and Use of Blood Products in Major Surgery: A Pooled Analysis of Randomized Clinical Trials
TLDR
Blood loss and transfusion requirements can be significantly reduced in major surgery when using third generation HES 130/ 0.4 (Voluven®) compared to second generation waxy maize starch HES 200/0.5.
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