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Understanding the harms of HES: A review of the evidence to date

Ünal MN, Reinhart K
2 December, 2019  

Hydroxyethyl starch (HES) was once commonly used in resuscitation procedures in the intensive care unit, but its selection was mostly preferential, with no robust evidence of clear benefits.

Owing to its association with increased risk of severe renal disease and death versus crystalloids, particularly in cases of sepsis and septic shock, it is no longer included or recommended in US and European treatment guidelines in critical care. However, this IV fluid is still administered in some regions of the world such as Turkey, where high mortality rates due to sepsis and septic shock have been reported with low awareness of the side effects and current recommendations in these settings.

This article reviews the indications, dosing, and side effects for crystalloids and synthetic and traditional colloids used in resuscitation in Turkey, with a focus on safety data for HES.

The authors strongly discourage its administration in the event of sepsis and critical illness, as well as for patients undergoing major surgery given the absence of high-quality data proving efficacy in the surgical setting.

The article also reviews recommended practices for patients with chronic liver disease, including risk-benefit assessments and continuous monitoring for kidney injury.