LAUSR

haemoglobin-based oxygen carrier solution (HBOC)] from 1997 to 2011 reported less blood loss and better survival after use of HES 130/0.4 (tetrastarch). A more recent meta-analysis also calculated less blood loss after tetrastarch versus crystalloids. Raiman et al. compared different HES generations–not only HES 130/0.4 (tetrastarch) –to any other fluid (except HBOC) from 2000 to 2015. Less trials were included compared with the previous analysis, but more blood loss and transfusions were reported after tetrastarch infusion. A recent prospective multicentre observational trial including more than 4000 patients from ICUs suggested lack of any problem with starches when used in everyday practice, that is following a careful clinical indication by an intensivist and not a rigid study protocol enforcing clinicians to do things they would never do voluntarily.