Recent meta-analyses have compared the effect of HES with comparators on the risk of mortality in critically ill patients. These have looked carefully at the risk of methodological bias and statistical heterogenicity but seemed to ignore whether or not patients had an indication for colloids. Studies included patients who were > 6 h from shock to randomization, without reproducible indicators of hypovolemia, without any algorithm for hemodynamic stabilization or without any algorithm for onset of renal replacement therapy. Any drug given without a correct indication will not benefit but harm. Accordingly, no further meta-analyses are needed. Rather, better trials on whether HES may be harmful when their use is limited to immediate hemodynamic stabilization should be conducted.
– Sibylle Kozek-Langenecker