n South African Medical Journal - Starch safety in resuscitation - when will we ever learn? : forum - clinical practice
|Article Title||Starch safety in resuscitation - when will we ever learn? : forum - clinical practice|
|© Publisher:||Health and Medical Publishing Group (HMPG)|
|Journal||South African Medical Journal|
|Affiliations||1 Walter Sisulu University, 2 Rhodes University, 3 University of Cape Town and 4 University of Cape Town|
|Publication Date||Jun 2013|
|Pages||365 - 367|
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.
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