The key decision: Forgoing treatment or maintaining care

Saralegui, I.; Manzano, Alberto Blázquez; Corral, Esther

doi:10.1016/j.jcrc.2010.06.014

Cited by 2 publications

(8 citation statements)

References 7 publications

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“…Supporting this hypothesis, several studies showed a ratio of the amounts of HES and crystalloids that was higher than 1:1 [1,2,5,18,20]. In the 6S trial [3] contrarily, the cumulative amount of study drug did not differ between the HES and crystalloid group during the first 3 days.…”

Section: Resultsmentioning

confidence: 94%

“…Four studies considered follow-up until 90-day mortality [1-3,18], three studies 28-/30-day mortality [6,7,19], whereas four studies reported only early mortality (24-h, ICU, or hospital mortality) [4,5,20,21]. …”

Section: Resultsmentioning

confidence: 99%

“…Duration of fluid administration ranged from 90 min [6], 24 h [5,21], 96 h [1,18] up to a maximum of 90 days [2,3]. The ratio of the amounts of HES and crystalloids ranged between 1:1 [3,4,6,19,21], 1:1.1 [7], 1:1.2 [2,18,20], 1:1.3 [1], up to a maximum of 1:2.4 [5].…”

Section: Resultsmentioning

confidence: 99%

“…The ratio of the amounts of HES and crystalloids ranged between 1:1 [3,4,6,19,21], 1:1.1 [7], 1:1.2 [2,18,20], 1:1.3 [1], up to a maximum of 1:2.4 [5]. …”

Section: Resultsmentioning

confidence: 99%

“…However, prolonged administration of HES after the initial phase of haemodynamic instability increases the risk of giving HES to non-hypovolaemic patients [5-7,13,17]. Thus, persistent use with presumably weak indication has no beneficial effect or may even be harmful.…”

Section: Resultsmentioning

confidence: 99%

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Re-evaluating currently available data and suggestions for planning randomised controlled studies regarding the use of hydroxyethyl starch in critically ill patients - a multidisciplinary statement

et al. 2013

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IntroductionHydroxyethyl starch (HES) is a commonly used colloid in critically ill patients. However, its safety has been questioned in recent studies and meta-analyses.MethodsWe re-evaluated prospective randomised controlled trials (RCT) from four meta-analyses published in 2013 that compared the effect of HES with crystalloids in critically ill patients, focusing on the adherence to 'presumably correct indication'. Regarding the definition of 'presumably correct indication', studies were checked for the following six criteria (maximum six points): short time interval from shock to randomisation (<6 h), restricted use for initial volume resuscitation, use of any consistent algorithm for haemodynamic stabilisation, reproducible indicators of hypovolaemia, maximum dose of HES, and exclusion of patients with pre-existing renal failure or renal replacement therapy.ResultsDuration of fluid administration ranged from 90 min up to a maximum of 90 days. Four studies considered follow-up until 90-day mortality, three studies 28-/30-day mortality, whereas four studies reported only early mortality. Included studies showed a large heterogeneity of the indication score ranging between 1 and 4 points with a median (25%; 75% quartile) of 4 (2; 4).ConclusionsThe most important question, whether or not HES may be harmful when it is limited to immediate haemodynamic stabilisation, cannot be answered yet in the absence of any study sufficiently addressing this question. In order to overcome the limitations of most of the previous studies, we now suggest an algorithm emphasising the strict indication of HES. Additionally, we give a list of suggestions that should be adequately considered in any prospective RCT in the field of acute volume resuscitation in critically ill patients.

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Section: Resultsmentioning

confidence: 94%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…The ratio of the amounts of HES and crystalloids ranged between 1:1 [3,4,6,19,21], 1:1.1 [7], 1:1.2 [2,18,20], 1:1.3 [1], up to a maximum of 1:2.4 [5]. …”

Section: Resultsmentioning

confidence: 99%