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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

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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, I 2 = 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, I 2 = 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.

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Acknowledgments

The authors acknowledge Dr Nancy Jiang for assistance with language translation. Sources of funding: This study was funded by the Division of Critical Care & Trauma, George Institute for Global Health. JM is supported by a Practitioner Fellowship from the National Health and Medical Research Council.

Author information

Authors and Affiliations

  1. The George Institute for Global Health, Sydney, Australia

    David J. Gattas, Arina Dan, John Myburgh, Laurent Billot, Serigne Lo & Simon Finfer

  2. Royal Prince Alfred Hospital, University of Sydney, Missenden Rd, Camperdown, Sydney, NSW 2050, Australia

    David J. Gattas

  3. St George Hospital, University of New South Wales, Sydney, Australia

    John Myburgh

  4. Royal North Shore Hospital, University of Sydney, Sydney, Australia

    Simon Finfer

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  1. David J. Gattas
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CHEST Management Committee

Corresponding author

Correspondence to David J. Gattas.

Additional information

Crystalloid versus Hydroxyethyl Starch Trial (CHEST) Management Committee: John Myburgh (chair), Rinaldo Bellomo, Alan Cass, Maryam Correa, Simon Finfer, David Gattas, Parisa Glass, Julie Harland, Joanne Lee, Jeffrey Lipman, Bette Liu, Colin McArthur, Shay McGuinness, Maryanne Ng, Dorrilyn Rajbhandari, Colman Taylor, Steve Webb and Lynsey Willenberg.

This article is discussed in the editorial available at doi:10.1007/s00134-013-2854-7.

Appendix

Appendix

Electronic Search strategy. The intersection of: fluid resuscitation, hydroxyethyl starch, and randomized controlled trials.

MEDLINE.

1. exp Fluid Therapy.

2. ((fluid$ or volume$ or plasma$ or rehydrat$) adj3 (replace$ or therap$ or substitut$ or restor$ or resuscitat$ or rehydrat$)).ab,ti.

3. or/1-2.

4. exp Starch.

5. exp Blood Substitutes.

6. exp Colloids.

7. hetastarch$.tw.

8. hydroxyethyl starch.tw.

9. hydroxyethylstarch.tw.

10. hydroxy ethyl starch.tw.

11. pentastarch.tw.

12. voluven$.tw.

13. tetrastarch.tw.

14. or/4-13.

15. 3 and 14.

16. limit 15 to “therapy (sensitivity)” [from the MEDLINE limit ‘Clinical Queries’, based on Haynes et al [52].].

EMBASE.

#14. #3 AND #12 AND #13.

#13. random:ti OR ‘clinical trial’:de,rn,ab,ti OR ‘health care quality’/exp.

#12. #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11.

#11. tetrastarch.

#10. voluven*.

#9. pentastarch.

#8. ‘hydroxy ethyl starch’.

#7. hydroxyethylstarch.

#6. ‘hydroxyethyl starch’.

#5. hetastarch*.

#4. ‘starch’/exp OR starch.

#3. #1 OR #2.

#2. (fluid* OR volum* OR plasma* OR rehydrat*) NEAR/3 (therap* OR substitut* OR restor* OR resusc* OR replac*).

#1. ‘fluid therapy’/exp OR ‘fluid therapy’.

CENTRAL.

#1 starch* or *starch or voluven* in Clinical Trials.

#2 MeSH descriptor Fluid Therapy explode all trees.

#3 ((fluid* or volume* or plasma* or rehydrat*) NEAR/3 (replace* or therap* or substitut* or restor* or resuscitat* or rehydrat*)):ab,ti in Clinical Trials.

#4 (#2 OR #3).

#5 (#1 AND #4).

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Gattas, D.J., Dan, A., Myburgh, J. et al. 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. Intensive Care Med 39, 558–568 (2013). https://doi.org/10.1007/s00134-013-2840-0

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