Twisting and ignoring facts on hydroxyethyl starch is not very helpful

Large randomized trials on critically ill patients have related the
use of hydroxyethyl starch (HES) to negative outcomes. In a recent
comment we explained in detail why, from our point of view,
transferring the results of VISEP, 6S and CHEST into daily ICU
practice is as difficult as their extrapolation to perioperative
treatment. Haase, Muller and Perner lately challenged this
analysis. However, after having carefully read their letter to the
editor we are happy to demonstrate that all points we made were
absolutely correct. We agree with Haase et al. that a debate on HES
safety is important, but has to be based on facts. The difference
might be that we like to thoroughly discuss all of them, including
the main one: VISEP, 6S and CHEST do not capture the initial
stabilization of their hemodynamically instable patients. The vast
majority, including those patients later assigned to the
"crystalloid" groups, had been stabilized with colloids before
study onset. This is not a big problem, but has to be discussed
carefully and honestly to prevent the data from being
misinterpreted by users and official authorities.