UMEM Educational Pearls

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.

References

http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/ucm358271.htm

Perner A., et al. Hydroxyethyl Starch 130/0.4 versus Ringer's Acetate in Severe Sepsis. NEJM. 2012 Jun 27.

MyBurgh, J. Hydroxyethyl Starch or Saline for Fluid Resuscitation in Intensive Care. N Engl J Med. 2012 Oct 17.

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