OBJECTIVE  To develop and validate a risk prediction model for venous thromboembolism in the first six weeks after delivery (early postpartum). DESIGN  Cohort study. SETTING  Records from England based Clinical Practice Research Datalink (CPRD) linked to Hospital Episode Statistics (HES) and data from Sweden based registry. PARTICIPANTS  All pregnant women registered with CPRD-HES linked ...

We read with interest the article by Meybohm and colleagues regarding the use of hydroxyethyl starch (HES) in critically ill patients [1]. Although we may agree with their conclusion that the most important question is whether or not HES may be harmful, we cannot agree with their suggestion on further clinical use based only on strict indication for HES or a safety checklist. In recent major ra...

Severe persistent pruritus is a common, but incompletely characterized, complication of hydroxyethyl starch (HES) infusion. This retrospective study aimed to assess HES-induced pruritus by electron microscopic findings, pruritus characteristics, and response to stimuli, and to determine the impact of HES dosage, molecular weight and substitution. Seventy patients with electron micro-scopy-prove...

Isoflurane is a commonly used inhalation anesthetic in species undergoing veterinary care that induces hypotension, impacting organ perfusion, making it imperative to minimize its occurrence or identify effective strategies for treating it. This study evaluated and compared the hemodynamic effects of DOB, NEP, VAS, HES twelve isoflurane-anesthetized Beagle dogs. The order first three treatments...

In a recent issue of Critical Care, Brandt and colleagues report the effects of a 'liberal' fluid loading protocol compared to a more 'restrictive' protocol on hemodynamics and mortality in pigs in which septic shock had been induced. It appears that the former protocol was associated with higher mortality in spite of improved hemodynamics compared to the latter. The results of the paper are di...

Rates of urinary excretion concomitant with the molecular size distribution of filtered polymer fragments were determined in five normovolaemic men dosed with 30 g/m2 BSA of a species of HES (HES 350/0.60) possessing a M-W of 350 000 combined with an MS of 0.60. Approximately 13% of the total injected dose of HES 350/0.60 was excreted in urine 1 hr after dosing, and 45% by 72 hours. Gel filtrat...

The choice of which intravenous solution to prescribe remains a matter of considerable debate in intensive care units around the world. Trends have been moving away from using hydroxyethyl starch solutions following concerns about safety. But are the available data sufficient to clearly assess the risk-benefit balance for all patients, and is there enough evidence of harm to justify removing th...

This review summarises the new insights into the physiology of perioperative fluid therapy and analyses recent studies of the safety of the use of HES solutions in the fluid management of critically ill patients. This analysis reveals a number of methodological issues in the three major studies that have initiated the recommendation of the European Medicine Agency to ban hydroxyethyl starches f...

*The research for this paper was funded by an Australian Research Council Discovery Grant (DP 0773489). The authors are grateful to the Australian Bureau of Statistics for their permission to use the HES unit record data sets and to Dr. Paul Blacklow for permitting the use of demand parameter estimates obtained by him. Helpful comments from seminar participants at the University of Melbourne ar...