Hydroxyethyl starch for perioperative fluid management: a critical appraisal

Schmidt, André; Bilotta, Federico

doi:10.1016/j.bjane.2023.07.004

Cited by 1 publication

(4 citation statements)

References 14 publications

(17 reference statements)

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“…Wei et al [17] reported evidence of increased blood loss in 216 patients receiving HA compared to 222 patients receiving HES during cardiac surgery, without an increase in transfusion requirements. Increased bleeding in the HA group compared with the HES group in adult cardiac surgery contradicts previous meta-analytic evidence [39] and may be prone to bias [26]. The use of HES has recently been severely restricted owing to safety concerns [32].…”

Section: Discussionmentioning

confidence: 86%

“…The analysis showed no differences in mortality or total infusion between the two groups. However, given the safety concerns and the changing approval status of HES globally [ 26 ], the results of this study are likely to be secondary.…”

Section: Resultsmentioning

confidence: 99%

“…The results of the assessments of the methodological quality of the meta-analyses are shown in Table S2 . Regarding the seven critical questions of the AMSTAR-2 tool, the following findings were observed among the included meta-analyses: three meta-analyses published a review protocol prior to conducting the review [ 18 , 20 , 23 ] (Q2); all of them performed a comprehensive literature search (Q4); three provided a list of excluded studies or reasons for exclusion [ 18 , 20 , 23 ] (Q7); seven meta-analyses employed a satisfactory approach for assessing the risk of bias [ 13 , 15 , 17 , 18 , 20 , 24 ] (Q9); all meta-analyses, except one published as congress report without showing details [ 22 ] used appropriate statistical methods for data synthesis (Q11); three meta-analyses failed to account for the risk of bias in individual studies when interpreting the results [ 16 , 21 , 22 ] (Q13); and seven meta-analyses thoroughly investigated publication bias [ 15 , 17 , 18 , 19 , 20 , 23 , 26 ] (Q15).…”

Section: Resultsmentioning

confidence: 99%

“…The use of HES has recently been severely restricted owing to safety concerns [ 32 ]. In addition, there is strong evidence of reporting bias in the meta-analysis [ 26 ], further weakening the evidence. Thus, meta-analyses of the last five years do not add to the body of knowledge on the use of HA in cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

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Human Albumin Infusion in Critically Ill and Perioperative Patients: Narrative Rapid Review of Meta-Analyses from the Last Five Years

Wiedermann

2023

JCM

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Background: Human albumin, a vital plasma protein with diverse molecular properties, has garnered interest for its therapeutic potential in various diseases, including critical illnesses. However, the efficacy of albumin infusion in critical care and its associated complications remains controversial. To address this, a review of recent meta-analyses was conducted to summarize the evidence pertaining to albumin use in critical illness. Methods: Adhering to the rapid review approach, designed to provide a concise synthesis of existing evidence within a short timeframe, relevant meta-analyses published in the last five years were identified and analyzed. PubMed, Embase, and Cochrane databases of systematic reviews were searched using pre-defined search terms. Eligible studies included meta-analyses examining the association between albumin infusion and outcomes in critically ill and perioperative patients. Results: Twelve meta-analyses were included in the review, covering diverse critical illnesses and perioperative scenarios such as sepsis, cardiothoracic surgery, and acute brain injury. The analyses revealed varying levels of evidence for the effects of albumin use on different outcomes, ranging from no significant associations to suggestive and convincing. Conclusions: Albumin infusion stabilizes hemodynamic resuscitation endpoints, improves diuretic resistance, and has the potential to prevent hypotensive episodes during mechanical ventilation in hypoalbuminemic patients and improve the survival of patients with septic shock. However, caution is warranted due to the methodological limitations of the included studies. Further high-quality research is needed to validate these findings and inform clinical decision-making regarding albumin use in critical care.

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