Hydroxyethyl starch (HES) is a colloid used for volume resuscitation in critically-ill patients.
Previous studies (click here) have compared crystalloids to HES during fluid resuscitation and have demonstrated that HES has an increased cost with more adverse effects. Adverse effects may include:
Coagulopathy
Acute kidney injury
Increased mortality
In the United States, the Federal Drug Administration published a warning on June 24th 2013 with respect to the use of HES in critically ill adult patients. Specifically, it warned about the use of HES in patients,
with sepsis
with pre-existing kidney injury
admitted to the ICU
undergoing heart surgery with cardiopulmonary bypass
If a decision to use HES is made, the FDA warning advises to:
discontinue use of HES at the first sign of renal injury or coagulopathy
continue to monitor renal function for at least 90 days (all patients)
Bottom line: With an increased cost and evidence of harm compared to crystalloids, it appears the indications for use of HES are rapidly declining.
