Hydroxyethyl starch versus other fluids for non-septic patients in the intensive care unit: a meta-analysis of randomized controlled trials

Abstract

IntroductionUse of hydroxyethyl starch (HES) in septic patients is reported to increase the mortality and incidence of renal replacement therapy (RRT). However, whether or not use of HES would induce the same result in non-septic patients in the intensive care unit (ICU) remains unclear. The objective of this meta-analysis was to evaluate 6% HES versus other fluids for non-septic ICU patients.MethodsRandomized controlled trials (RCTs) were searched from Pubmed, OvidSP, Embase database and Cochrane Library, published before November, 2013. A meta-analysis was made on the effect of 6% HES versus other fluids for non-septic ICU patients, including mortality, RRT incidence, bleeding volume, red blood cell (RBC) transfusion and fluid application for non-septic patients in ICU.ResultsTwenty-two RCTs were included, involving 6,064 non-septic ICU patients. Compared with the other fluids, 6% HES was not associated with decreased overall mortality (RR = 1.03, 95%CI: 0.09 to 1.17; P = 0.67; I2 = 0). There was no significant difference in RRT incidence, bleeding volume and red blood cell transfusion between 6% HES group and the other fluid groups. However, patients in HES group received less total intravenous fluids than those receiving crystalloids during the first day in ICU (SMD = −0.84; 95%CI: −1.39 to −0.30; P = 0.003, I2 = 74%).ConclusionsThis meta-analysis found no increased mortality, RRT incidence, bleeding volumes or RBC transfusion in non-septic ICU patients, but the sample sizes were small and the studies generally were of poor quality.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-0833-9) contains supplementary material, which is available to authorized users.

Faulty risk-of-bias assessment in a meta-analysis of hydroxyethyl starch for non-septic ICU patients: a rebuttal

“…In our view, the FIRST study meets all of the criteria for assessment as a low risk of bias study and we dispute the concession made by He et al [ 4 ] regarding the risk of bias of this study. Our view is that the original analysis in the published paper reflects the correct scientific position and that the modified Jadad score of 6 allocated to this study is appropriate.…”

Use of infusion solutions in critically ill: Literature review

“…U cilju procene uticaja 6% HES-a na smrtnost, upotrebu terapije u cilju potpore bubrežne funkcije, krvarenja, potrebe za transfuzijom krvi i nadoknadom tečnosti kod neseptičnih pacijenata, nastala je meta analiza koja je obuhvatila 22 klinič-ke randomizovane studije. Glavni rezultati te studije pokazuju da ukupna smrtnost i upotreba terapije u cilju potpore bubrežne funkcije nisu bile pogoršane primenom HES-a 48 . Nadoknada tečnosti kod pacijenata sa opekotinama U osnovi nastanka opekotinske bolesti je masivni sistemski inflamatorni odgovor, usled oslobađa-nja brojnih medijatora, i veliko oštećenje kapilarne membrane sa gubitkom tečnosti u intersticijumu.…”

Hydroxyethyl starch for volume expansion after subarachnoid haemorrhage and renal function: Results of a retrospective analysis

“…However, its safety during elective surgery or in non-septic patients is still under debate. A recent meta-analysis of 22 randomized controlled trials comparing HES with different fluids (Gelatine, crystalloids or Albumin) in non-septic patients in intensive care units could not demonstrate a difference in the need for renal replacement therapy (RRT) [ 9 ]. On the other hand, impairment of renal function after HES administration could be demonstrated in non-septic elderly trauma patients [ 10 ].…”