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aHES solution in a balanced salt carrier, was introduced intoclinical practice. Since HES solutions are drugs (drugidentication number 02278057), it could be argued thatthey should have been reviewed by the hospitals’ Phar-macy and Therapeutics Committees before they wereadded to the hospital formulary. In most cases, however,the responsibility within hospitals came under the materialservices department, which is the same department thathandles the distribution of the crystalloids. As a result, theevaluation of the HES solutions for therapeutic efcacyand safety was largely bypassed at the hospital level, andby most accounts, their use went unchecked at the hospitallevel.The recent publications of large randomized trialscomparing HES solutions with crystalloids in critically illpatients

Starches for fluid therapy: Is it time for a re-appraisal, or has the horse left the barn?