Understanding the Harms of HES: A Review of the Evidence to Date

Özet

Intravenous (IV) fluid resuscitation is one of the most common interventions in intensive care medicine. Despite clear guidelines, the choice ofIV fluid is largely dependent on physician preference instead of high-quality evidence of efficacy and safety. This is particularly the case for synthetic colloids, such as hydroxyethyl starch (HES). The use of HES in critical care has been associated with increased rates of acute kidney injury(AKI), renal replacement therapy and mortality. In light of this, current guidelines and scientific and regulatory bodies do not recommend theuse of HES for fluid therapy in critical illness and caution against its use in many other settings. Despite this, HES products are still debated andused. Awareness of the indications, contraindications, doses, benefits and adverse effects for IV fluids, as well as recommendations from scientificand regulatory bodies, is essential to guarantee patients’ safety. Poor awareness of optimal IV fluid therapy has recently been revealed in somecountries including Turkey. Therefore, we provide a review of fluids used for resuscitation, discuss safety data and adverse effects of HES, suchas increased AKI and mortality, and discuss recent updates from scientific and regulatory bodies in order to raise awareness of fluid therapy. Weconclude that given the lack of a clear benefit of HES in any clinical setting and the availability of safer alternatives, such as crystalloids andalbumin, HES should be avoided.