Controversies in the use of hydroxyethyl starch solutions in small animal emergency and critical care

Adamik, Katja‐Nicole; Yozova, Ivayla D.; Stokar-Regenscheit, Nadine

doi:10.1111/vec.12283

Cited by 47 publications

(73 citation statements)

References 298 publications

(509 reference statements)

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“…Recent studies suggest that the beneficial effect of HES in relation to COP and edema formation requires an intact glycocalyx: the colloid binds to the glycocalyx, increasing its COP, and limits transendothelial flow independent of the attained plasma COP concentrations. The binding capacity of HES to the glycocalyx is a determining factor and HES fails to limit transendothelial flow when the glycocalyx is damaged . In line with this theory, maintaining plasma COP or plasma albumin concentrations in critically ill human patients offers no clinical benefit .…”

Section: Current Published Human Research Information and Datamentioning

confidence: 99%

“…In line with this theory, maintaining plasma COP or plasma albumin concentrations in critically ill human patients offers no clinical benefit . Increasing plasma COP with HES when the glycocalyx is damaged might even be counterproductive, since HES might extravasate and exacerbate edema formation …”

Section: Current Published Human Research Information and Datamentioning

confidence: 99%

“…HES binds to circulating von Willebrand's factor–factor VIII complexes, resulting in quicker complex elimination and platelet dysfunction . Furthermore, HES induce weaker clot formation and increased fibrinolysis, lead to fibrinogen deficiency, and induces altered platelet function . The duration and severity of coagulopathy are suggested to be less important with tetrastarch than penta‐ or hetastarch, and effects are dose–dependent .…”

Section: Current Published Human Research Information and Datamentioning

confidence: 99%

“…Furthermore, HES induce weaker clot formation and increased fibrinolysis, lead to fibrinogen deficiency, and induces altered platelet function . The duration and severity of coagulopathy are suggested to be less important with tetrastarch than penta‐ or hetastarch, and effects are dose–dependent . In people HES administration was associated with increased blood loss, risk and reoperation for bleeding, and the need for blood products compared to albumin or to crystalloids …”

Section: Current Published Human Research Information and Datamentioning

confidence: 99%

“…Until recently, hydroxyethyl starches (HES) were considered the fluid of choice for resuscitation in human medicine . However, Joachim Boldt, author of a large body of scientific literature on the use of HES in people, was discredited for unethical research practices .…”

Section: Introductionmentioning

confidence: 99%

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Hydroxyethyl starches in equine medicine

Galen

Hallowell

2019

J Vet Emergen Crit Care

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Objective To review and discuss the use of hydroxyethyl starches (HES) in equine veterinary medicine, and to provide recommendations for its use. Data sources Veterinary and human peer‐reviewed medical literature including scientific reviews, meta‐analyses, and original research articles. Human data synthesis Increasing evidences on adverse effects after HES use and decreasing support for beneficial effects with regards to volume expansion and colloid osmotic pressure (COP) support in critically ill subjects have led to a recent guideline to limit the use of HES in critically ill people. Equine veterinary data synthesis The rationale for HES use in horses is mainly extrapolated from human medicine, and very limited studies in horses are available. There is limited evidence suggesting a superiority of volume expansion effects of HES over crystalloids. The potential for HES to increase and maintain COP is well supported, but there is no evidence that maintaining or increasing plasma COP influences outcome, tissue edema formation, or rates of complications that potentially relate to edema formation. HES induce dose–dependent changes in coagulopathic parameters, but there is no evidence that HES causes clinical coagulopathies. Insufficient data are available on other adverse effects such as acute kidney injury, or mortality in horses. The use of HES should be restricted in septic patients, but may still have some use in cases of hemorrhagic shock resuscitation, hypoalbuminemia, or perioperative fluid replacement. Conclusion The evidence supporting the use of HES in horses is weak due to lack of species‐specific investigations. Acknowledging species differences, the use of HES should be judicious, yet with some recognition of its benefits in particular cases. More research is necessary to improve knowledge on use of HES in horses and to establish better future recommendations.

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Section: Current Published Human Research Information and Datamentioning

confidence: 99%

Section: Current Published Human Research Information and Datamentioning

confidence: 99%