• S. Afr. Med. J. · Jun 2013

    Review

    Starch safety in resuscitation - when will we ever learn?

    • Andy Parrish and Marc Blockman.
    • Department of Internal Medicine, Frere and Cecilia Makiwane Hospitals, East London, South Africa. andygp@mweb.co.za
    • S. Afr. Med. J. 2013 Jun 1;103(6):365-7.

    AbstractRecent 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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