LAUSR

The first is considering the safety of hydroxyethyl starch (HES) in critically ill patients, especially taking into consideration the European Commission’s rules and restrictions on HES usage, issued on 17 July 2018. Our study protocol was designed, and the trial started with the recruitment of patients, years before this regulation came into effect. Also, we feel that the decision to erase HES from clinical practice was not supported by very strong evidence as this decision was based on the results of clinical trials that did not apply adequate haemodynamic monitoring and the fluid administration was based on clinicians’ intuition or on inadequate indices. These trials have an important message: if the current approach in fluid management is used, then normovolaemic patients will be treated with cristalloids or HES, and complications are inevitable. In other words, it may be that it is not the HES, but our current clinical practice that is responsible for the harmful effects of HES observed in these trials. In our study, in contrast to these large trials, we implemented the concept of detailed, multimodal and individualised, haemodynamic monitoring, to maximise the likelihood that only those patients who were most probably hypovolaemic would treated with fluids.