Letters to the Editor: Letters & Announcements
We disagree with Wiedermann1 who suggests that the development of hydroxyethyl starch (HES) with different physico-chemical characteristics over more than 30 yr has not improved its safety. In the cited study from Schortgen et al.,2 negative effects of hypertonic colloids (human albumin 20% and HES 10%) on kidney function in patients with shock have been shown. The specific kind of 10% HES used in this study has not been identified. Regarding kidney function, Blasco et al.3 showed that in patients undergoing kidney transplant use of 6% HES 130/0.4 in saline resulted in significantly lower creatinine levels compared with that in patients to whom 6% HES 200/0.62 saline was given—even 1 yr after administration of HES. We are not able to comment on Wiedermann’s Ref. 3 (in press) and papers published after publication of our paper could obviously not have been cited (Dr. Wiedermann’s Ref. 9).
Hartog and Reinhart comment that “the use of starches is controversial.”4 This is true for many substances and strategies in medicine! The use of crystalloids (e.g., saline solution) or human albumin for correcting severe hypovolemia are both controversially discussed strategies.4–6 So is the use of many other substances.
Interestingly, Hartog and Reinhart claim that “proof of benefit of HES is still lacking.” However, the extensive clinical experience of many thousands of anesthetists, intensivists, or physicians worldwide who have used HES to stabilize hemodynamics cannot be ignored. I suggest that the selective listing of a few studies (including abstracts) showing possible risks of some HES preparations in very selected patients does not justify the authors’ final conclusion that “there is no good reason to use” the most modern HES preparation with a low Mw of <200 kD and a molar substitution of <0.5.
Prof. Dr. Joachim Boldt
Clinic of Anesthesiology and Intensive Care Medicine
1.Wiedermann CJ. Hydroxyethyl starch 130/0.4: does “modern” mean safe? Anesth Analg 2009;109:1346–7
2.Schortgen F, Girou E, Deye N, Brochard L; for the CRYCO Study Group. The risk associated with hyperoncotic colloids in patients with shock. Intensive Care Med 2008;34:2157–68
3.Blasco V, Leone M, Antonini F, Geissler A, Albanèse J, Martin C. Comparison of the novel hydroxyethylstarch 130/0.4 and hydroxyethylstarch 200/0.6 in brain-dead donor resuscitation on renal function after transplantation. Br J Anaesth 2008;100: 504–8
4.Hartog C, Reinhart K. Modern starches are not safer than old ones. Anesth Analg 2009;109:1346
5.Green RS, Hall RI. Con: starches are not preferable to albumin during cardiac surgery: a contrary opinion. J Cardiothorac Vasc Anesth 2008;22:485–91
6.James MF. Pro: hydroxyethyl starch is preferable to albumin in the perioperative management of cardiac patients. J Cardiothorac Vasc Anesth 2008;22:482–4