The role of hydroxyethyl starch in resuscitation in the ICU

Protagonists of HES solutions have based their arguments on the benefits of colloids over crystalloids, specifically, better intravascular volume expansion and maintenance of colloid oncotic pressure. However, these physiologically based properties have increasingly been questioned following insights into the effects of acute inflammation on the regulatory role of the endothelial glycocalyx, and the role of the microcirculation, specifically autonomically mediated lymphatic clearance of interstitial fluid. 2 The improving knowledge of these effects has caused a re-evaluation of the effectiveness of colloids to remain within the intravascular space under pathological conditions such as sepsis, trauma and general anaesthesia, when resuscitation fluids are commonly administered. The potential for colloids to maintain intravenous volume and cause oedema is probably no different to that of crystalloids. The results of recent high-quality randomised controlled trials (RCTs) have added further to these observations. The ratio of albumin:saline observed in the Saline versus Albumin Fluid Evaluation (SAFE) study was 1:1.4, suggesting a relative equivalence in the volume expansion effect, and no difference in mortality or organ failure