Fluid resuscitation with 6 % hydroxyethyl starch (130/0.4 and 130/0.42) in acutely ill patients: systematic review of effects on mortality and treatment with renal replacement therapy.

The authors sought to determine whether fluid resuscitation of acutely ill patients with hydroxyethyl starch (HES) compared with other resuscitation fluids results in a difference in the relative risk of death or need for renal replacement therapy (RRT). This new meta-analysis summarizes essentially two major studies published in 2012 – the 6S and CHEST trials – and one personal communication that included more than 77% of included patients (8001/10391 patients). These three studies, of the 35 trials included, had the lowest risk of bias. The authors observed no significant effect of resuscitation fluid on the relative risk of mortality (relative risk, 1.08; 95% CI, 1.00 to 1.17), but an increased risk of requiring RRT in patients who received HES (relative risk, 1.25; 95 % CI, 1.08 to 1.44). This new meta-analysis updates older meta-analyses that already indicated adverse effects of HES and suggested limiting their use in critically ill patients.

– Michael Piagnerelli