Debate on use of hydroxyethyl starch for fluid resuscitation in septic patients

Fluid resuscitation is the most importantelementary care in the management of sepsis. In recent years,choice of fluid types has become one of the hot debate topicsin the field. Based on recent RCTs,use of hydroxyethyl starch130/0.4 or 0.42(HES 130/0.4 or 0.42) for volume therapy hasbeen associated with an increased need of renal replacementtherapy(RRT) notably and high risk of 90-day mortality inseptic patients significantly. According to a systematical andintensive analysis on the available published data,evidencewas insufficient for identifying HES 130/0.4 or 0.42-inducedacute kidney injury(AKI) in patients with sepsis. Furthermore,a high heterogeneity on HES 130/0.4 or 0.42 associatedmortality was found among RCTs in comparison withcrystalloids in septic patients. And the results of HES 130/0.4or 0.42 associated increase of mortality were likely confoundedin the original trials. Therefore,further valid data is needed forobjectively evaluating the safety of HES 130/0.4 or 0.42 administration for volume therapy in patients with sepsis.