Which colloid solution is associated with dose-dependent coagulopathy (reduction in von Willebrand factor and Factor VIII activity) and is now contraindicated in ICU and trauma patients based on CHEST and 6S trial evidence?

• A 4.5% Human albumin solution
• B Gelatin-based colloids (Gelofusine)
• C Hydroxyethyl starch (HES 130/0.4 — Voluven) ✓
• D 5% Dextrose in saline

Explanation

Hydroxyethyl starch (HES) solutions are associated with acute kidney injury (increased RRT requirement — CHEST and 6S trials, 2012), coagulopathy (impaired platelet function, reduced vWF and Factor VIII), and tissue accumulation. The EMA and FDA have restricted HES use in ICU and trauma patients. The CHEST trial (HES vs. 0.9% NaCl in ICU) showed higher RRT requirement with HES. Gelatin-based colloids are still used (though evidence of harm in sepsis is emerging), while human albumin is safe in sepsis (SAFE trial).

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.