Volume resuscitation with HES-solutions : A review of the latest literature

Fluid administration in perioperative and critically ill patients is an everyday challenge that requires careful consideration between risks and benefits for the individual patient.Hydroxyethylstarch (HES) preparations have been used for volume resuscitation in these patients for decades worldwide.In October 2013,however,the European Medicines Agency (EMA) recommended not to use HES solutions in patients with sepsis,burn injuries,renal impairment,severe coagulopathy as well as critically ill patients in general.This recommendation was based on the results of mainly three randomized,controlled trials; all of them being heavily criticized for the study protocol and data interpretation.This review provides a brief overview over the pharmacodynamics and pharmacokinetics of HES preparations,the differences between individual HES generations and the pathophysiology of critically ill and perioperative patients.Furthermore,recent randomized,controlled trials investigating volume resuscitation with HES in critical ill patients and in the perioperative setting with a special focus on cardiac surgery were critically discussed. Key words: hetastarch ;  fluid therapy