Hydroxyethyl starches, such as Hespan, Voluven, Volulyte, Tetrahes and Hestar, have been shown in several large trials to increase the risk of acute kidney injury (AKI) and/or the need for renal replacement therapies among critically ill patients, particulalry those suffering sepsis.
Evidence demonstrating harm among fit & healthy surgical patients is however lacking, notably Giles et al could find no increased risk of adverse event among surgical patients in their 2014 meta-analysis. Nonetheless, given the similar lack of demonstrable benefit of HES fluids for this group, avoidance of use in both the ICU and surgical population is prudent.summary
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A growing collection of landmark papers relevant to intensive care and critical care medicine.
These papers are practice changing and hold current, ongoing significance beyond their historical importance.
This is a dynamic and changing document that will be updated, pruned and added to as appropriate. Many of these papers have free full-text provided by the publisher because of their significance.summary