Starch safety in resuscitation – when will we ever learn?
Recent trials have failed to demonstrate a survival benefit from the use of hydroxyethyl starches (HES) as a colloid in fluid resuscitation and have raised concerns of renal harm. In severe sepsis, there is a concerning signal of increased mortality. New high-quality systematic reviews consistently demonstrate a statistically non-significant relative risk of death of 1.08 - 1.10 and a significant 25% increased chance of requiring renal replacement therapy. The HES literature contains many industry-affiliated reviews of indifferent quality. Traditional efficacy confidence limits may warrant re-evaluation when considering these harms. Newer formulations of HES and more focused indications for use show benefit on surrogate endpoints, but these trials are currently underpowered to ensure safety.
Andy Parrish, Department of Internal Medicine, Frere and Cecilia Makiwane hospitals, East London; affiliated to Walter Sisulu University, Rhodes University and University of Cape Town, South Africa
Marc Blockman, Department of Internal Medicine, Division of Clinical Pharmacology, Groote Schuur Hospital and University of Cape Town, South Africa
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Date published: 2013-04-29
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