Article

Fluid Resuscitation with 6% Hydroxyethyl Starch (130/0.4) in Acutely Ill Patients: An Updated Systematic Review and Meta-Analysis

Critical Care & Trauma Division, The George Institute for Global Health, University of Sydney, Australia. .a
Anesthesia and analgesia (Impact Factor: 3.42). 01/2012; 114(1):159-69. DOI: 10.1213/ANE.0b013e318236b4d6
Source: PubMed

ABSTRACT Recent research suggests that 6% hydroxyethyl starch (HES) 130/0.4 is one of the most frequently used resuscitation fluids worldwide. The retraction of studies evaluating its use necessitates a reevaluation of available evidence regarding its safety and efficacy.
We performed a systematic review and meta-analysis of unretracted randomized controlled trials comparing the effects of 6% HES 130/0.4 with other colloid or crystalloid solutions on mortality, acute kidney injury/failure, and bleeding in acutely ill or perioperative patients. A sensitivity analysis including the data from retracted studies was also conducted.
Overall, 36 studies reporting 2149 participants met the inclusion criteria, of which 11 (n = 541) have been retracted. Of the remaining 25 studies, there was a high risk of bias in 17 studies; 19 studies (n = 1246) were conducted in perioperative patients and 6 (n = 362) in critically ill patients. Sixteen studies reported mortality: 104 deaths in 1184 participants. The relative risk of death was 0.95 (95% confidence interval 0.64-1.42, I(2) = 0%, P = 0.73); including the retracted studies added a further 14 deaths and the relative risk was 0.92 (95% confidence interval 0.63-1.34, I(2) = 0%, P = 0.95). The data reporting acute kidney injury, red blood cell transfusion, and bleeding were of insufficient quantity and quality and not amenable to meta-analysis.
Published studies are of poor quality and report too few events to reliably estimate the benefits or risks of administering 6% HES 130/0.4. This same conclusion is reached with or without the retracted studies. Given the widespread use of 6% HES 130/0.4, high-quality trials reporting a large number of events are urgently required.

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    • "o r g Please cite this article as: Serpa Neto A, et al, Fluid resuscitation with hydroxyethyl starches in patients with sepsis is associated with an increased incidence of acute kidney..., J Crit Care (2013), http://dx.doi.org/10.1016/j.jcrc.2013.09.031 with sepsis confirms earlier findings of harm from HES [16], as do other meta-analyses comparing resuscitation with HES with resuscitation with other fluids in critically ill patients [2] [17]. Notably, these meta-analyses did not focus on patients with sepsis, but included studies of unselected critically ill patients [2] [17]. "
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