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Hydroxyethylstärke (HES)

Hydroxyethylstärke (HES)

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Summary

Adequate volume replacement therapy is a mainstay of managing the critically ill. The ideal kind of volume replacement in this situation still remains a challenge. In spite of an immense number of contributions to this problem there is still no definite answer. The ideal volume replacement strategy should not only aim at maintaining stable systemic hemodynamics, organ perfusion and microcirculation should be guaranteed or even improved as well. Due to its excellent efficacy, hydroxyethylstarch (HES) preparations are widely used to treat hypovolemia. The different physico-chemical properties of the available HES solutions, however, should be taken into account. Anphylactoid reactions as well as negative effects on coagulation, kidney/liver function and on the immune system are frequently used arguments against the administration of HES, but they can virtually be neglected when using modern HES preparations to correct hypovolemia. There are, however, still open questions concerning the use of HES in children, pregnant patients, patients with altered kidney function and in burn patients.

Zusammenfassung

Ein adäquater Volumenersatz ist bei der Behandlung des schwerkranken Patienten von zentraler Bedeutung. Obwohl die Arbeiten zu diesem Thema nahe zu unübersehbar sind, ist die Wahl des „idealen” Volumenersatzes auch heute noch umstritten. Bei der Auswahl des Volumenersatzes muss nicht nur die Normalisierung der Hypovolämie-bedingten Veränderungen der Makrozirkulation berücksichtigt werden, eine Verbesserung der Organperfusion bzw. der Mikrozirkulation muss ebenfalls Ziel einer suffizienten Volumenersatztherapie sein. Auf Grund der hohen Effektivität kommen zum Ausgleich einer Hypovolämie im deutschsprachigen Raum häufig Hydroxyethylstärke-(HES) Präparationen zum Einsatz, wobei jedoch unbedingt die unterschiedlichen physiko-chemischen Eigenschaften der jeweiligen Lösungen berücksichtigt werden müssen. Anaphylaktoide Reaktionen sowie unerwünschte Nebenwirkungen auf das Gerinnungssystem, die Nieren- und Leberfunktion und die Immunantwort werden immer wieder als Gegenargumente angeführt, sind aber bei HES-Präparationen neuerer Generation weitgehend zu vernachlässigen. Trotzdem bleiben offene Fragen, die insbesondere den Einsatz bei Kindern, Schwangeren, Patienten mit eingeschränkter Nierenfunktion und bei Verbrennungspatienten betreffen.

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  1. Klinik für Anästhesiologie and Operative Intensivmedizin, Klinikum der Stadt Ludwigshafen, Bremserstraße 79, D-67063, Ludwigshafen, Deutschland

    Joachim Boldt

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Boldt, J. Hydroxyethylstärke (HES). Wien Klin Wochenschr 116, 159–169 (2004). https://doi.org/10.1007/BF03040482

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