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

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ÜNAL M. N., Reinhart K.

TURKISH JOURNAL OF ANAESTHESIOLOGY AND REANIMATION, cilt.47, sa.2, ss.81-91, 2019 (ESCI) identifier identifier identifier

  • Yayın Türü: Makale / Derleme
  • Cilt numarası: 47 Sayı: 2
  • Basım Tarihi: 2019
  • Doi Numarası: 10.5152/tjar.2019.72681
  • Dergi Adı: TURKISH JOURNAL OF ANAESTHESIOLOGY AND REANIMATION
  • Derginin Tarandığı İndeksler: Emerging Sources Citation Index (ESCI), Scopus, TR DİZİN (ULAKBİM)
  • Sayfa Sayıları: ss.81-91
  • Anahtar Kelimeler: Acute kidney injury, AKI, critical illness, crystalloids, colloids, fluids, HES, hydroxyethyl starch, mortality, resuscitation, sepsis, HYDROXYETHYL STARCH 130/0.4, ACUTE KIDNEY INJURY, RENAL REPLACEMENT THERAPY, FLUID RESUSCITATION, CARDIOPULMONARY BYPASS, VOLUME RESUSCITATION, MORTALITY, METAANALYSIS, COAGULATION, SEPSIS
  • Ankara Üniversitesi Adresli: Evet

Özet

Intravenous (IV) fluid resuscitation is one of the most common interventions in intensive care medicine. Despite clear guidelines, the choice of IV 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 TIES in critical care has been associated with increased rates of acute kidney injury (AM), renal replacement therapy and mortality. In light of this, current guidelines and scientific and regulatory bodies do not recommend the use of TIES for fluid therapy in critical illness and caution against its use in many other settings. Despite this, HES products arc still debated and used. Awareness of the indications, contraindications, doses, benefits and adverse effects for IV fluids, as well as recommendations from scientific and regulatory bodies, is essential to guarantee patients' safety. Poor awareness of optimal IV fluid therapy has recently been revealed in some countries including Turkey. Therefore, we provide a review of fluids used for resuscitation, discuss safety data and adverse effects of TIES, such as increased AKI and mortality, and discuss recent updates from scientific and regulatory bodies in order to raise awareness of fluid therapy. We conclude that given the lack of a clear benefit of HES in any clinical setting and the availability of safer alternatives, such as crystalloids and albumin, HES should be avoided.