Effect of hydroxyethyl starch vs saline for volume replacement therapy on death or postoperative complications among high-risk patients undergoing major abdominal surgery: the FLASH randomized clinical trial.

There are few drugs that have gone through such a rollercoaster ride as hydroxyethyl starch (HES). While shortly after its introduction the belief still prevailed that all types of volume deficiency could be best treated with HES, this picture has changed considerably in recent years. A number of more or less well-done studies have been able to show that patients with sepsis have a high risk of renal failure after HES infusion. However, in the course of these studies, it was never completely clear whether these results could be transferred to normal, abdominal surgery patients.

Futier et al. have tried to close this gap with their randomised controlled trial. The protocol and the experimental design of this study are very professional, and subsequently the results can very well be used as clinical guidelines. However, as with all other trials, the interpretation is not entirely clear. Although there is no difference between the two groups for the primary composite outcome, HES tends to be inferior to saline for secondary parameters related to renal function. However, this does not seem to be of great clinical importance.

Overall, HES also seems to have an influence on perioperative renal function in abdominal surgery. However, the results suggest that this has only a minor influence on perioperative morbidity and mortality.

– Jens Meier