Hydroxyethyl Starch- Friend or Foe?

Resuscitation with intravenous fluid therapy is considered a corner stone in the management of critically ill patients in most acute conditions. In daily practice, the assessment of individual thresholds in order to optimize cardiac preload and avoid hypovolemia or deleterious fluid overload remains a challenge.

The choice of fluids for intravascular volume replacement has been debated for decades. More recently, this debate has focused not only on colloids versus crystalloids, but more specifically on the choice of colloid solutions.

Hydroxyethyl starch (HES) solutions, developed as less-expensive alternatives to albumin, are commonly employed for volume resuscitation in the perioperative period as well as in ICU patients. However, lately, the resuscitation with HES has become controversial due to its adverse effect regarding impaired coagulation, renal insufficiency and mortality.

Therefore, a narrative review of recent literature was undertaken to establish the current utility and efficacy of HES in clinical practice. Prospective randomized controlled trials published between January 2008 and March 2015 with measures of outcome/mortality and adverse effects of HES administration were included. This review aims at increasing awareness amongst anesthetists and critical care specialist about correct and careful fluid administration.