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

David Gattas; Arina Dan; John Myburgh; Laurent Billot; Serigne Lo; Simon Finfer; Rinaldo Bellomo; Alan Cass; Maryam Correa; Parisa Glass; Julie Harland; J Lee; Jeffrey Lipman; Bette Liu; Colin McArthur; Shay McGuinness; Maryanne Ng; Dorrilyn Rajbhandari; Colman Taylor; Steven Webb; Lynsey Willenberg

doi:10.1007/s00134-013-2840-0

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

David Gattas, Arina Dan, John Myburgh, Laurent Billot, Serigne Lo, Simon Finfer, Rinaldo Bellomo, Alan Cass, Maryam Correa, Parisa Glass, Julie Harland, J Lee, Jeffrey Lipman, Bette Liu, Colin McArthur, Shay McGuinness, Maryanne Ng, Dorrilyn Rajbhandari, Colman Taylor, Steven WebbLynsey Willenberg

Wellbeing and Preventable Chronic Disease

Research output: Contribution to journal › Article › peer-review

137 Citations (Scopus)

Abstract

Purpose: To determine whether fluid resuscitation of acutely ill adults with 6 % hydroxyethyl starch (6 % HES 130) with a molecular weight of 130 kD and a molar substitution ratio of approximately 0.4 (6 % HES 130) compared with other resuscitation fluids results in a difference in the relative risk of death or treatment with renal replacement therapy (RRT).

Methods: Systematic review and meta-analysis of randomized controlled trials comparing intravascular fluids for resuscitation of hospitalised adults that reported mortality or treatment with RRT. The risk of bias was assessed independently by two reviewers and meta-analysis was performed using random effects.

Results: Thirty-five trials enrolling 10,391 participants were included. The three largest trials had the lowest risk of bias, were published (or completed) in 2012, and together enrolled 77 % of all participants. Death occurred in 928 of 4,691 patients (19.8 %) in the 6 % HES 130 group versus 871 of 4,720 (18.5 %) in the control fluid groups relative risk (RR) in the 6 % HES 130 group 1.08, 95 % confidence interval (CI) 1.00 to 1.17, I2 = 0 %). Treatment with RRT occurred in 378 of 4,236 patients (8.9 %) in the 6 % HES 130 group versus 306 of 4,260 (7.2 %) in the control fluid group (RR in the 6 % HES 130 group 1.25, 95 % CI 1.08 to 1.44, I2 = 0 %).

Conclusions: The quality and quantity of data evaluating 6 % hydroxyethyl starch (130/0.4 and 130/0.42) as a resuscitation fluid has increased in the last 12 months. Patients randomly assigned to resuscitation with 6 %HES 130 are at significantly increased risk of being treated with RRT.

Original language	English
Pages (from-to)	558-568
Number of pages	11
Journal	Intensive Care Medicine
Volume	39
Issue number	4
DOIs	https://doi.org/10.1007/s00134-013-2840-0
Publication status	Published - 2013

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Gattas, D., Dan, A., Myburgh, J., Billot, L., Lo, S., Finfer, S., Bellomo, R., Cass, A., Correa, M., Glass, P., Harland, J., Lee, J., Lipman, J., Liu, B., McArthur, C., McGuinness, S., Ng, M., Rajbhandari, D., Taylor, C., ... Willenberg, L. (2013). 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. Intensive Care Medicine, 39(4), 558-568. https://doi.org/10.1007/s00134-013-2840-0

@article{36bcdc30f1db48ce854c3c9cf3b1db8e,

title = "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",

abstract = "Purpose: To determine whether fluid resuscitation of acutely ill adults with 6 % hydroxyethyl starch (6 % HES 130) with a molecular weight of 130 kD and a molar substitution ratio of approximately 0.4 (6 % HES 130) compared with other resuscitation fluids results in a difference in the relative risk of death or treatment with renal replacement therapy (RRT).Methods: Systematic review and meta-analysis of randomized controlled trials comparing intravascular fluids for resuscitation of hospitalised adults that reported mortality or treatment with RRT. The risk of bias was assessed independently by two reviewers and meta-analysis was performed using random effects.Results: Thirty-five trials enrolling 10,391 participants were included. The three largest trials had the lowest risk of bias, were published (or completed) in 2012, and together enrolled 77 % of all participants. Death occurred in 928 of 4,691 patients (19.8 %) in the 6 % HES 130 group versus 871 of 4,720 (18.5 %) in the control fluid groups relative risk (RR) in the 6 % HES 130 group 1.08, 95 % confidence interval (CI) 1.00 to 1.17, I2 = 0 %). Treatment with RRT occurred in 378 of 4,236 patients (8.9 %) in the 6 % HES 130 group versus 306 of 4,260 (7.2 %) in the control fluid group (RR in the 6 % HES 130 group 1.25, 95 % CI 1.08 to 1.44, I2 = 0 %).Conclusions: The quality and quantity of data evaluating 6 % hydroxyethyl starch (130/0.4 and 130/0.42) as a resuscitation fluid has increased in the last 12 months. Patients randomly assigned to resuscitation with 6 %HES 130 are at significantly increased risk of being treated with RRT.",

author = "David Gattas and Arina Dan and John Myburgh and Laurent Billot and Serigne Lo and Simon Finfer and Rinaldo Bellomo and Alan Cass and Maryam Correa and Parisa Glass and Julie Harland and J Lee and Jeffrey Lipman and Bette Liu and Colin McArthur and Shay McGuinness and Maryanne Ng and Dorrilyn Rajbhandari and Colman Taylor and Steven Webb and Lynsey Willenberg",

year = "2013",

doi = "10.1007/s00134-013-2840-0",

language = "English",

volume = "39",

pages = "558--568",

journal = "Intensive Care Medicine",

issn = "0342-4642",

publisher = "Springer",

number = "4",

}

Gattas, D, Dan, A, Myburgh, J, Billot, L, Lo, S, Finfer, S, Bellomo, R, Cass, A, Correa, M, Glass, P, Harland, J, Lee, J, Lipman, J, Liu, B, McArthur, C, McGuinness, S, Ng, M, Rajbhandari, D, Taylor, C, Webb, S & Willenberg, L 2013, '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', Intensive Care Medicine, vol. 39, no. 4, pp. 558-568. https://doi.org/10.1007/s00134-013-2840-0

TY - JOUR

T1 - Fluid resuscitation with 6 % hydroxyethyl starch (130/0.4 and 130/0.42) in acutely ill patients

T2 - systematic review of effects on mortality and treatment with renal replacement therapy

AU - Gattas, David

AU - Dan, Arina

AU - Myburgh, John

AU - Billot, Laurent

AU - Lo, Serigne

AU - Finfer, Simon

AU - Bellomo, Rinaldo

AU - Cass, Alan

AU - Correa, Maryam

AU - Glass, Parisa

AU - Harland, Julie

AU - Lee, J

AU - Lipman, Jeffrey

AU - Liu, Bette

AU - McArthur, Colin

AU - McGuinness, Shay

AU - Ng, Maryanne

AU - Rajbhandari, Dorrilyn

AU - Taylor, Colman

AU - Webb, Steven

AU - Willenberg, Lynsey

PY - 2013

Y1 - 2013

N2 - Purpose: To determine whether fluid resuscitation of acutely ill adults with 6 % hydroxyethyl starch (6 % HES 130) with a molecular weight of 130 kD and a molar substitution ratio of approximately 0.4 (6 % HES 130) compared with other resuscitation fluids results in a difference in the relative risk of death or treatment with renal replacement therapy (RRT).Methods: Systematic review and meta-analysis of randomized controlled trials comparing intravascular fluids for resuscitation of hospitalised adults that reported mortality or treatment with RRT. The risk of bias was assessed independently by two reviewers and meta-analysis was performed using random effects.Results: Thirty-five trials enrolling 10,391 participants were included. The three largest trials had the lowest risk of bias, were published (or completed) in 2012, and together enrolled 77 % of all participants. Death occurred in 928 of 4,691 patients (19.8 %) in the 6 % HES 130 group versus 871 of 4,720 (18.5 %) in the control fluid groups relative risk (RR) in the 6 % HES 130 group 1.08, 95 % confidence interval (CI) 1.00 to 1.17, I2 = 0 %). Treatment with RRT occurred in 378 of 4,236 patients (8.9 %) in the 6 % HES 130 group versus 306 of 4,260 (7.2 %) in the control fluid group (RR in the 6 % HES 130 group 1.25, 95 % CI 1.08 to 1.44, I2 = 0 %).Conclusions: The quality and quantity of data evaluating 6 % hydroxyethyl starch (130/0.4 and 130/0.42) as a resuscitation fluid has increased in the last 12 months. Patients randomly assigned to resuscitation with 6 %HES 130 are at significantly increased risk of being treated with RRT.

AB - Purpose: To determine whether fluid resuscitation of acutely ill adults with 6 % hydroxyethyl starch (6 % HES 130) with a molecular weight of 130 kD and a molar substitution ratio of approximately 0.4 (6 % HES 130) compared with other resuscitation fluids results in a difference in the relative risk of death or treatment with renal replacement therapy (RRT).Methods: Systematic review and meta-analysis of randomized controlled trials comparing intravascular fluids for resuscitation of hospitalised adults that reported mortality or treatment with RRT. The risk of bias was assessed independently by two reviewers and meta-analysis was performed using random effects.Results: Thirty-five trials enrolling 10,391 participants were included. The three largest trials had the lowest risk of bias, were published (or completed) in 2012, and together enrolled 77 % of all participants. Death occurred in 928 of 4,691 patients (19.8 %) in the 6 % HES 130 group versus 871 of 4,720 (18.5 %) in the control fluid groups relative risk (RR) in the 6 % HES 130 group 1.08, 95 % confidence interval (CI) 1.00 to 1.17, I2 = 0 %). Treatment with RRT occurred in 378 of 4,236 patients (8.9 %) in the 6 % HES 130 group versus 306 of 4,260 (7.2 %) in the control fluid group (RR in the 6 % HES 130 group 1.25, 95 % CI 1.08 to 1.44, I2 = 0 %).Conclusions: The quality and quantity of data evaluating 6 % hydroxyethyl starch (130/0.4 and 130/0.42) as a resuscitation fluid has increased in the last 12 months. Patients randomly assigned to resuscitation with 6 %HES 130 are at significantly increased risk of being treated with RRT.

U2 - 10.1007/s00134-013-2840-0

DO - 10.1007/s00134-013-2840-0

M3 - Article

SN - 0342-4642

VL - 39

SP - 558

EP - 568

JO - Intensive Care Medicine

JF - Intensive Care Medicine

IS - 4

ER -

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

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