A Questionnaire based study on practice and safety concerns of hydroxyethyl starch as fluid management among Critical Care Physicians, Gynecologists and Surgeons in India

Abstract

Introduction: Use of natural and synthetic colloid solutions to replenish intravascular volume depletion is common in diverse clinical settings. Hydroxyethyl starches (HES) are a common choice for fluid resuscitation and are preferred over albumin because of their relatively lower price.However its association with increased risk of bleeding, renal dysfunction and mortality in patients who had sepsis or were critically ill compared with crystalloids usage posed concern. In 2013, the FDA issued a “black box” warning about increased mortality and severe renal injury in critically ill patients, advising that it should not be used in this population. The present study highlights the issue and probes on its current usage in India. Objective: To assess the usage pattern and adverse events of synthetic colloids such as hydroxyethyl starch in fluid management through a questionnaire survey among critical care physicians, gynecologists and surgeons. Methodology: A questionnaire based study was conducted among 156 critical care physicians, gynecologists and surgeonspan-India, where physicians were approached through emails and a pre-designed, pre-tested questionnaire presented in Google form was sent to potential respondents. Data was checked for completeness and then analyzed by appropriate statistical methods as applicable. Results: Majority of the respondents were noted usingHES despite its adverse potential, due to its availability at government hospitals. Surprisingly a few of the interviewed surgeons use HES as a volume expander. Similar results were obtained from the interviewed gynecologists and obstetricians. Among 52 interviewed gynecologists, only 2% use HES as volume expander. Conclusion: Considering the adverse potential of this synthetic colloid and justifying the risk and benefit analysis one has to be very wise in selecting the right synthetic colloid for the right patient. However with current concerns about safety of hydroxyethyl starch products, almost all interviewed physicians recommended regulatory restriction over their use in India.