Webcast: Does use of hetastarch (HES) in severe sepsis and septic shock lead to increase risk of renal failure?
In this edition of the series, Dr. Molinar provides an excellent review of the different types of hetastarches available along with associated pharmacokinetic and pharmacodynamic profiles.
CLICK HERE TO VIEW THE RECORDED JOURNAL CLUB WEBINAR
This is followed by Dr. Ahn’s review and discussion of the Schortgen et al. study in Lancet 2001. This was thew first “larger” study to evaluate hetastarch and its possible deleterious effect on the kidneys when compared to Gelatin in a multi-center randomized trial in France.
Finally, not until 2008 did we have a large multi-center German study called the VISEP trial published in NEJM which looked at severe sepsis and septic shock patients and compared Hetastarch to Lactated ringers (along with evaluation of intensive vs conventional glucose control). This too as a secondary endpoint ealuated the effects of therapy on renal failure and need for RRT. Although this trial was stopped prematurely because of severe hypoglycemic episodes in the intensive insulin therapy group, it is still the single largest multicenter trial to date looking at the outcomes of septic patients receiving Hetastarch.
These two trials really are the basis of what I have termed the “anti-hextend” movement in the critical care community however they are marked by a myriad of SIGNIFICANT design and statistical FLAWS which have also led to widespread criticism. This journal club webinar aims to dig deep into the analysis of these two trials and was a very engaging and though provoking session. Please FEEL free to comment below and let the discussion continue!!
