In Response to Colloids Use in Asian ICU Patients: Do not Mix Oranges with Apples. Consider the Proven Concerns on Hydroxyethyl Starch Use in ICU patients | JoVE Visualize

In Response to Colloids Use in Asian ICU Patients: Do not Mix Oranges with Apples. Consider the Proven Concerns on Hydroxyethyl Starch Use in ICU patients

Christian Ertmer¹

¹Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany.

Indian Journal of Critical Care Medicine : Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine|June 28, 2021

View abstract on PubMed

Summary

Hydroxyethyl starch (HES) solutions are not recommended for intensive care unit (ICU) patients due to safety concerns. This response emphasizes avoiding comparisons between different colloid solutions, especially in Asian ICU populations.

Area of Science:

Critical Care Medicine
Pharmacology
Fluid Management

Background:

Colloid solutions, including hydroxyethyl starch (HES), are used for fluid resuscitation in intensive care units (ICUs).
Recent studies and regulatory actions have raised significant concerns regarding the safety and efficacy of HES products.
Comparisons between different colloid solutions must be scientifically rigorous and avoid inappropriate analogies.

Purpose of the Study:

To address the inappropriate comparison of hydroxyethyl starch (HES) use in Asian ICU patients with other colloid solutions.
To highlight the established safety concerns associated with HES administration in critically ill patients.
To advocate for evidence-based decision-making in fluid management strategies.

Main Methods:

Literature review of studies on HES use in ICU patients.
Analysis of safety data and regulatory warnings concerning HES products.
Critical evaluation of comparative studies on colloid solutions.

Main Results:

Hydroxyethyl starch (HES) is associated with increased risks of kidney injury and coagulopathy in ICU patients.
Studies comparing HES with other colloids, such as albumin, have shown varying results, often confounded by patient populations and study designs.
The "oranges and apples" analogy highlights the need for careful consideration of specific product characteristics and patient factors.

Conclusions:

The use of hydroxyethyl starch (HES) in intensive care unit (ICU) patients is associated with significant safety concerns and should be approached with caution.
Inappropriate comparisons between different colloid solutions, particularly in diverse populations like those in Asian ICUs, can lead to flawed conclusions.
Clinical decisions regarding fluid management should be based on robust evidence, considering the specific risks and benefits of each agent, rather than generalizations.