Mashed potatoes and maize: are the starches safe?

244 February 2013 I N 1831 during the European cholera epidemic, Latta1 was the first to report on a patient who was successfully resuscitated with intravenous fluids. He injected 60 ounces of warm saline intravenously to a pulseless cholera patient. According to the author’s report, on receiving the fluid resuscitation, every symptom of cholera was removed. About 80 yr later, fluid resuscitation with colloids was introduced to clinical medicine for treatment of severe hemorrhage. In his case series report published in JAMA in 1915, Hogan2 noted that although salt solutions give a temporary rise in blood pressure (and improvement in the general symptoms resulting from hemorrhage), he could obtain a more permanent rise with gelatin, a hydrophilic colloidal solution. In the same report, Dr. Hogan included the caveat that resuscitation with colloids is insufficient to treat toxemic shock despite the initial effects of colloid resuscitation on blood pressure. This differential effect on outcome of patients presenting with hemorrhagic and septic shock should be kept in mind when interpreting the results from current trials. Hydroxyethyl starches (HES) are the most commonly used colloids in many parts of the world;3however, recent studies suggest that HES may be associated with worse outcomes, when given for fluid resuscitation to patients with sepsis.4,5 Outcome data on the topic of colloid resuscitation are sparse, which is probably why it still raises strong opinions from key opinion leaders in the field. In this issue of ANEStHESIOLOgy, two groups of researchers provide important new data on the safety and potential benefits of modern 6% HES. Silva et al. 6 show in a preclinical model of hemorrhage and lung injury that potato-derived 6% HES resuscitation compares favorably with crystalloid and gelatin–based fluid resuscitation in terms of variables reflecting pulmonary and renal injury. The meta-analysis of Martin et al.7 reports on the absence of renal toxicity of maize-derived HES given to 1,230 patients undergoing a variety of surgical procedures.