Intensive Care Medicine

, Volume 39, Issue 4, pp 558–568

Fluid resuscitation with 6 % hydroxyethyl starch (130/0.4 and 130/0.42) in acutely ill patients: systematic review of effects on mortality and treatment with renal replacement therapy

  • David J. Gattas
  • Arina Dan
  • John Myburgh
  • Laurent Billot
  • Serigne Lo
  • Simon Finfer
  • CHEST Management Committee
Original

DOI: 10.1007/s00134-013-2840-0

Cite this article as:
Gattas, D.J., Dan, A., Myburgh, J. et al. Intensive Care Med (2013) 39: 558. doi:10.1007/s00134-013-2840-0

Abstract

Purpose

To determine whether fluid resuscitation of acutely ill adults with 6 % hydroxyethyl starch (6 % HES 130) with a molecular weight of 130 kD and a molar substitution ratio of approximately 0.4 (6 % HES 130) compared with other resuscitation fluids results in a difference in the relative risk of death or treatment with renal replacement therapy (RRT).

Methods

Systematic review and meta-analysis of randomized controlled trials comparing intravascular fluids for resuscitation of hospitalised adults that reported mortality or treatment with RRT. The risk of bias was assessed independently by two reviewers and meta-analysis was performed using random effects.

Results

Thirty-five trials enrolling 10,391 participants were included. The three largest trials had the lowest risk of bias, were published (or completed) in 2012, and together enrolled 77 % of all participants. Death occurred in 928 of 4,691 patients (19.8 %) in the 6 % HES 130 group versus 871 of 4,720 (18.5 %) in the control fluid groups relative risk (RR) in the 6 % HES 130 group 1.08, 95 % confidence interval (CI) 1.00 to 1.17, I2 = 0 %). Treatment with RRT occurred in 378 of 4,236 patients (8.9 %) in the 6 % HES 130 group versus 306 of 4,260 (7.2 %) in the control fluid group (RR in the 6 % HES 130 group 1.25, 95 % CI 1.08 to 1.44, I2 = 0 %).

Conclusions

The quality and quantity of data evaluating 6 % hydroxyethyl starch (130/0.4 and 130/0.42) as a resuscitation fluid has increased in the last 12 months. Patients randomly assigned to resuscitation with 6 %HES 130 are at significantly increased risk of being treated with RRT.

Keywords

Hetastarch Colloids Fluid therapy Resuscitation Critical illness 

Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2013

Authors and Affiliations

  • David J. Gattas
    • 1
    • 2
  • Arina Dan
    • 1
  • John Myburgh
    • 1
    • 3
  • Laurent Billot
    • 1
  • Serigne Lo
    • 1
  • Simon Finfer
    • 1
    • 4
  • CHEST Management Committee
  1. 1.The George Institute for Global HealthSydneyAustralia
  2. 2.Royal Prince Alfred HospitalUniversity of SydneySydneyAustralia
  3. 3.St George HospitalUniversity of New South WalesSydneyAustralia
  4. 4.Royal North Shore HospitalUniversity of SydneySydneyAustralia