Hydroxyethyl starches in equine medicine.

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.