Starch safety in resuscitation - when will we ever learn?
Recent 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...
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| Veröffentlicht in: | SAMJ: South African Medical Journal 2013-06, Vol.103 (6), p.365-367 |
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| creator | Parrish, Andy Blockman, Marc |
| description | Recent 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. |
| doi_str_mv | 10.7196/samj.6969 |
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| ispartof | SAMJ: South African Medical Journal, 2013-06, Vol.103 (6), p.365-367 |
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| language | eng |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; African Journals Online (Open Access); Sabinet African Journals Open Access Collection; Alma/SFX Local Collection |
| subjects | Clinical Trials as Topic Colloids Fluid Therapy - methods Health aspects Health Care Sciences & Services Health Policy & Services Humans Hydroxyethyl Starch Derivatives - therapeutic use Medical Ethics Medicine, General & Internal Medicine, Legal Medicine, Research & Experimental Patient Safety Plasma Substitutes - therapeutic use Resuscitation Resuscitation - methods Safety and security measures Sepsis - therapy Starch |
| title | Starch safety in resuscitation - when will we ever learn? |
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