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Use of hydroxyethyl starch in critically ill patients
Critical Care volume 17, Article number: 455 (2013)
We read with interest the article by Meybohm and colleagues regarding the use of hydroxyethyl starch (HES) in critically ill patients . Although we may agree with their conclusion that the most important question is whether or not HES may be harmful, we cannot agree with their suggestion on further clinical use based only on strict indication for HES or a safety checklist.
In recent major randomized trials, HES reversed hypovolemia and improved hemodynamic parameters earlier than crystalloids [2–4]. However, despite this physiologic benefit of HES, clinical results move in the opposite direction. Strong signals of a higher incidence of organ dysfunction or higher mortality in critically ill patients in large clinical trials cannot be disregarded [2, 3, 5].
Before going into further clinical trials or suggesting strict indications, we should first re-evaluate the effect of HES on experimental models. Unless a clear advantage of HES over crystalloid is demonstrated, which so far has not been, we must give the benefit of the doubt to the patients and not to the drug.
Meybohm P, Van Aken H, De Gasperi A, De Hert S, Della Rocca G, Girbes AR, Gombotz H, Guidet B, Hasibeder W, Hollmann MW, Ince C, Jacob M, Kranke P, Kozek-Langenecker S, Loer SA, Martin CD, Siegemund M, Wunder C, Zacharowski K: Re-evaluating currently available data and suggestions for planning randomised controlled studies regarding the use of hydroxyethyl-starch in critically ill patients – a multidisciplinary statement. Crit Care 2013, 17: R166. 10.1186/cc12845
Brunkhorst FM, Engel C, Bloos F, Meier-Hellmann A, Ragaller M, Weiler N, Moerer O, Gruendling M, Oppert M, Grond S, Olthoff D, Jaschinski U, John S, Rossaint R, Welte T, Schaefer M, Kern P, Kuhnt E, Kiehntopf M, Hartog C, Natanson C, Loeffler M, Reinhart K, German Competence Network Sepsis (SepNet): Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med 2008, 358: 125-139. 10.1056/NEJMoa070716
Myburgh JA, Finfer S, Bellomo R, Billot L, Cass A, Gattas D, Glass P, Lipman J, Liu B, McArthur C, McGuinness S, Rajbhandari D, Taylor CB, Webb SA, CHEST Investigators; Australian and New Zealand Intensive Care Society Clinical Trials Group: Hydroxyethyl starch or saline for fluid resuscitation in intensive care. N Engl J Med 2012, 367: 1901-1911. 10.1056/NEJMoa1209759
Guidet B, Martinet O, Boulain T, Philippart F, Poussel JF, Maizel J, Forceville X, Feissel M, Hasselmann M, Heininger A, Van Aken H: Assessment of hemodynamic efficacy and safety of 6% hydroxyethylstarch 130/0.4 vs. 0.9% NaCl fluid replacement in patients with severe sepsis: the CRYSTMAS study. Crit Care 2012, 16: R94. 10.1186/cc11358
Perner A, Haase N, Guttormsen AB, Tenhunen J, Klemenzson G, Aneman A, Madsen KR, Moller MH, Elkjaer JM, Poulsen LM, Bendtsen A, Winding R, Steensen M, Berezowicz P, Søe-Jensen P, Bestle M, Strand K, Wiis J, White JO, Thornberg KJ, Quist L, Nielsen J, Andersen LH, Holst LB, Thormar K, Kjældgaard AL, Fabritius ML, Mondrup F, Pott FC, Møller TP, et al.: Hydroxyethyl starch 130/0.42 versus Ringer's acetate in severe sepsis. N Engl J Med 2012, 367: 124-134. 10.1056/NEJMoa1204242
CR received lecture and consultancy fees and travel expenses from Fresenius-Kabi. GB declares that they have no competing interests.
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Bugedo, G., Romero, C. Use of hydroxyethyl starch in critically ill patients. Crit Care 17, 455 (2013) doi:10.1186/cc13032
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