Hydroxyethyl starches in equine medicine.
Abstract: To review and discuss the use of hydroxyethyl starches (HES) in equine veterinary medicine, and to provide recommendations for its use. Methods: Veterinary and human peer-reviewed medical literature including scientific reviews, meta-analyses, and original research articles. Results: Increasing evidences on adverse effects after HES use and decreasing support for beneficial effects with regards to volume expansion and colloid osmotic pressure (COP) support in critically ill subjects have led to a recent guideline to limit the use of HES in critically ill people. Unassigned: The rationale for HES use in horses is mainly extrapolated from human medicine, and very limited studies in horses are available. There is limited evidence suggesting a superiority of volume expansion effects of HES over crystalloids. The potential for HES to increase and maintain COP is well supported, but there is no evidence that maintaining or increasing plasma COP influences outcome, tissue edema formation, or rates of complications that potentially relate to edema formation. HES induce dose-dependent changes in coagulopathic parameters, but there is no evidence that HES causes clinical coagulopathies. Insufficient data are available on other adverse effects such as acute kidney injury, or mortality in horses. The use of HES should be restricted in septic patients, but may still have some use in cases of hemorrhagic shock resuscitation, hypoalbuminemia, or perioperative fluid replacement. Conclusions: The evidence supporting the use of HES in horses is weak due to lack of species-specific investigations. Acknowledging species differences, the use of HES should be judicious, yet with some recognition of its benefits in particular cases. More research is necessary to improve knowledge on use of HES in horses and to establish better future recommendations.
© Veterinary Emergency and Critical Care Society 2019.
Publication Date: 2019-06-22 PubMed ID: 31228334DOI: 10.1111/vec.12854Google Scholar: Lookup
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- Journal Article
- Review
Summary
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The research article critically reviews the use of hydroxyethyl starches (HES) in equine medicine, exploring its advantages and disadvantages, particularly in relation to use in critically ill subjects. It highlights the need for further species-specific research to better understand the applications and limitations of HES in equine treatment.
Selection and Analysis of Published Literature
- The paper identifies and analyzes relevant medical literature, including veterinary and human-focused scientific reviews, meta-analyses, and original research articles to provide a comprehensive overivew of hydroxyethyl starches (HES) use in equine medicine.
Situation with HES in Human Medicine
- The article highlights that the usage of HES in human medicine has decreased due to emerging evidence of potential adverse effects and limited benefits related to volume expansion and colloid osmotic pressure (COP) support in critically ill patients.
Current Application in Equine Medicine
- The authors point out that the use of HES in horses is mainly extrapolated from human medicine and scarcely investigated, resulting in limited evidence supporting its effectiveness.
- While the ability of HES to increase and maintain COP in horses is supported, there’s no clear link between these effects and positive outcomes for horses regarding tissue edema formation or complication rates related to edema formation.
Potential Adverse Effects of HES
- The study draws attention to HES’s potential to cause dose-dependent changes in coagulopathic parameters, although there’s negligible evidence that it causes clinical coagulopathies.
- However, there is a lack of data on other possible adverse effects such as acute kidney injury or mortality in horses.
Usage Recommendations
- The usage of HES should be limited in septic patients, but the paper suggests that it may still have potential benefits in cases like hemorrhagic shock resuscitation, hypoalbuminemia, or perioperative fluid replacement.
- Despite limited evidence and potential risks, the authors acknowledge that HES could still yield benefits in specific situations.
Call for Further Research
- The paper concludes that further species-specific research is necessary to improve understanding of HES usage in equine medicine and establish better future recommendations for its application.
Cite This Article
APA
van Galen G, Hallowell G.
(2019).
Hydroxyethyl starches in equine medicine.
J Vet Emerg Crit Care (San Antonio), 29(4), 349-359.
https://doi.org/10.1111/vec.12854 Publication
Researcher Affiliations
- Medicine and Surgery, Department of Large Animal Science, University of Copenhagen, Copenhagen, Denmark.
- School of Veterinary Medicine and Surgery, University of Nottingham, Nottingham, UK.
MeSH Terms
- Animals
- Horse Diseases / therapy
- Horses
- Humans
- Hydroxyethyl Starch Derivatives / therapeutic use
- Plasma Substitutes / therapeutic use
Citations
This article has been cited 6 times.- Adamik KN, Stoffel MH, Tangermann S, de Breuyn Dietler B, Stokar-Regenscheit N. Assessment of Hydroxyethyl Starch (6% HES 130/0.4) Kidney Storage in Critically Ill Dogs: A Post-mortem Prospective Study. Front Vet Sci 2021;8:802507.
- Boyd CJ, Brainard BM, Smart L. Intravenous Fluid Administration and the Coagulation System. Front Vet Sci 2021;8:662504.
- Liu H, Wang H, Mu Z, Ye L, Jiang Y. Heat and moisture exchanger used in a cardiothoracic surgery intensive care unit: Airway resistance and changing interval. Turk Gogus Kalp Damar Cerrahisi Derg 2020 Oct;28(4):593-600.
- Zhao H, Zhu Y, Zhang J, Wu Y, Xiang X, Zhang Z, Li T, Liu L. The Beneficial Effect of HES on Vascular Permeability and Its Relationship With Endothelial Glycocalyx and Intercellular Junction After Hemorrhagic Shock. Front Pharmacol 2020;11:597.
- Hardefeldt L, Thomas K, Page S, Norris J, Browning G, El Hage C, Stewart A, Gilkerson J, Muscatello G, Verwilghen D, van Galen G, Bauquier J, Cuming R, Reynolds B, Whittaker C, Wilkes E, Clulow J, Burden C, Begg L. Antimicrobial prescribing guidelines for horses in Australia. Aust Vet J 2025 Dec;103(12):781-889.
- Woods Cuneo S, Abi-Nader BA, Blasczynski SJ, Chigerwe M. Effects of Plasma and Hetastarch Administration on Colloid Oncotic Pressure and Coagulation Variables in Dairy Calves and Goats. J Vet Intern Med 2025 May-Jun;39(3):e70079.
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