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Intensive Care Medicine

, Volume 38, Issue 3, pp 368–383 | Cite as

Consensus statement of the ESICM task force on colloid volume therapy in critically ill patients

  • Konrad Reinhart
  • Anders Perner
  • Charles L. Sprung
  • Roman Jaeschke
  • Frederique Schortgen
  • A. B. Johan Groeneveld
  • Richard Beale
  • Christiane S. Hartog
Special Article

Abstract

Purpose

Colloids are administered to more patients than crystalloids, although recent evidence suggests that colloids may possibly be harmful in some patients. The European Society of Intensive Care Medicine therefore assembled a task force to compile consensus recommendations based on the current best evidence for the safety and efficacy of the currently most frequently used colloids—hydroxyethyl starches (HES), gelatins and human albumin.

Methods

Meta-analyses, systematic reviews and clinical studies of colloid use were evaluated for the treatment of volume depletion in mixed intensive care unit (ICU), cardiac surgery, head injury, sepsis and organ donor patients. Clinical endpoints included mortality, kidney function and bleeding. The relevance of concentration and dosage was also assessed. Publications from 1960 until May 2011 were included. The quality of available evidence and strength of recommendations were based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

Recommendations and conclusions

We recommend not to use HES with molecular weight ≥200 kDa and/or degree of substitution >0.4 in patients with severe sepsis or risk of acute kidney injury and suggest not to use 6% HES 130/0.4 or gelatin in these populations. We recommend not to use colloids in patients with head injury and not to administer gelatins and HES in organ donors. We suggest not to use hyperoncotic solutions for fluid resuscitation. We conclude and recommend that any new colloid should be introduced into clinical practice only after its patient-important safety parameters are established.

Keywords

Recommendations Systematic review Colloids Hydroxyethyl starch Gelatin Albumin Adverse effects 

Notes

Acknowledgments

Support was provided solely from institutional and/or departmental sources.

Conflicts of interest

C.L.S., R.J., F.S., A.B.J.G., R.B., and C.S.H. declare no conflict of interest. A.P. has received support for research from B. Braun Medical and Fresenius Kabi and honoraria from Ferring Pharmaceuticals. A.B.J.G. has received unrestricted research grants from B. Braun in the past. K.R. has received unrestricted research grant for the conduct of the VISEP trial and consultancy fees from B. Braun Melsungen.

Supplementary material

134_2012_2472_MOESM1_ESM.doc (104 kb)
Supplementary material 1 (DOC 104 kb)

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Copyright information

© Copyright jointly held by Springer and ESICM 2012

Authors and Affiliations

  • Konrad Reinhart
    • 1
  • Anders Perner
    • 2
  • Charles L. Sprung
    • 3
  • Roman Jaeschke
    • 4
  • Frederique Schortgen
    • 5
  • A. B. Johan Groeneveld
    • 6
  • Richard Beale
    • 7
  • Christiane S. Hartog
    • 1
  1. 1.Department for Anesthesiology and Intensive Care Medicine, Jena University HospitalFriedrich-Schiller UniversityJenaGermany
  2. 2.Department of Intensive Care, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
  3. 3.Department of Anesthesiology and Critical Care MedicineHadassah Hebrew University Medical CenterJerusalemIsrael
  4. 4.Department of Medicine and Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonCanada
  5. 5.Réanimation Médicale, AP-HPGroupe Hospitalier Albert Chenevier, Henri MondorCréteilFrance
  6. 6.Erasmus Medical CentreRotterdamThe Netherlands
  7. 7.Department of Adult Critical CareGuy’s and St Thomas’ NHS Foundation TrustLondonUK

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