Consensus statement of the ESICM task force on colloid volume therapy in critically ill patients

Reinhart, Konrad; Perner, Anders; Sprung, Charles L.; Jaeschke, Roman; Schortgen, Frédérique; Groeneveld, A. B. Johan; Beale, Richard; Hartog, Christiane S.

doi:10.1007/s00134-012-2472-9

Cited by 231 publications

(133 citation statements)

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“…[5,13,14] The addition of the 6S [25] and CHEST [3] trials add 90% of the weight in this analysis that focuses on sepsis to address the clear knowledge gap of existing data identified by the ESICM Task Force committee. [7] The post hoc sub-group analysis of 6% tetrastarch origin was unsurprisingly not statistically significant for C2/C6 9-ratio waxy maize products, given the low power of 20.7% and the median baseline 90-day and overall mortality of 28.7% and 30%, respectively. However, generally concordant point estimates towards possible harm were found (Figures 4b and 5, online supplement).…”

Section: Discussionmentioning

confidence: 91%

“…6% tetrastarch products have an average molecular weight of 130 kDa (±20 kDa), and somewhat overlapping molar substitution [3] clinical use, the safety and efficacy of HES are controversial. [4][5][6][7] Large critical care randomised controlled trials (RCTs) in severe sepsis reporting harm from HES, [8,9] concern over publication bias supporting HES, [5,6] and retraction of studies, have raised safety and efficacy concerns. [4,[10][11][12] 6% tetrastarch products were studied in eleven retracted papers, [13] however, severe sepsis patients were not the main study population in these.…”

Section: Introductionmentioning

confidence: 99%

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Randomised trials of 6 % tetrastarch (hydroxyethyl starch 130/0.4 or 0.42) for severe sepsis reporting mortality: systematic review and meta-analysis

2013

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PurposeTo assess the impact of 6% tetrastarch (hydroxyethyl starch (HES) 130/0.4 and 130/0.42) in severe sepsis patients. The primary outcome measure was 90-day mortality. MethodsA structured literature search to identify prospective randomized controlled trials (RCT) in adult patients with severe sepsis receiving 6% tetrastarch (potato or waxy maize origin), as part of fluid resuscitation in comparison to other non-HES fluids after randomisation, in the critical care setting was undertaken. A systematic review and meta-analysis was performed. ResultsSix RCTs were included (n = 3033): three from 2012 (n = 2913) had a low risk of bias. Median tetrastarch exposure was 37.4 ml/kg (range 30 to 43). Ninety-day mortality was associated with tetrastarch exposure (relative risk (RR) 1.13; 95% confidence interval (CI) 1.02 to 1.25; p = 0.02) compared to crystalloid. The number needed to harm (NNH) was 28.8 (95% CI 14.6 to 942.5). Publication bias and statistical heterogeneity (I 2 = 0%) were not present. Tetrastarch exposure was also associated with renal replacement therapy (p = 0.01; NNH 15.7) and allogeneic transfusion support (p = 0.001; NNH 9.9). No difference between groups was observed for 28-day mortality, comparison with colloid as control, and for waxy maize derived tetrastarch, but power was lacking. Overall mortality was associated with tetrastarch exposure (RR 1.13; 95% CI 1.02 to 1.25; p = 0.02). ConclusionsIn our analysis, 6% tetrastarch as part of initial fluid resuscitation for severe sepsis was associated with harm, and as alternatives exist, in our view should be avoided.

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Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Randomised trials of 6 % tetrastarch (hydroxyethyl starch 130/0.4 or 0.42) for severe sepsis reporting mortality: systematic review and meta-analysis

2013

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“…Yüksek miktarda hızlı (>3 L) serum fizyolojik infüzyonu hiperkloremik metabolik asidoza neden olabileceğiden bu gibi durumlarda ringer laktata alternatif olarak laktat yerine asetat ve glukonat içeren dengeli elektrolit solüsyonları (Isolyte S ® -Plasmalyte ® ) kullanılabilir (2). Sentetik kolloidler (HES, Gelatin), sepsisli ve akut böbrek hasarı riski olan hastalarda böbrek yetersizliği ve koagülasyon bozukluğuna yol açabileceğinden literatürdeki son gelişmeler doğrultusunda KT uygulanan hastaların yoğun bakım tedavisinde dikkatli kullanılmalıdırlar (37,38). Doğal kolloidlerden albumin solüsyonları, hipoalbuminesi (<2,5 g/dL) olan KT uygulanmış hastalarda periferik ödemi ve asit oluşumunu kontrol altına almak, drenlerden gelen kaybı replase etmek amacıyla uygulanabilir (39)(40)(41).…”

Section: Sıvı Tedavisiunclassified

Critical Care Management after Adult Liver Transplantation

Akan¹

2017

tybdd

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1ÖZ Karaciğer transplantasyonu uygulanan hastaların yoğun bakım yönetimi çok yönlü bir izlemi ve multidisipliner bir yaklaşımı gerektirir. Günümüzde ideal bir yoğun bakım tedavisi için deneyimli bir ekibe ve gelişmiş yoğun bakım/hastane olanaklarına gereksinim vardır. Karaciğer transplantasyon olgularının postoperatif yoğun bakım yönetimi zaman içinde hızlı bir gelişme göstermiştir. Preoperatif optimizasyon, cerrahi teknik, intraoperatif anestezi yönetimi, organ prezervasyonu, yoğun bakım ve immünosüpresyon tedavilerindeki gelişmeler ile 1998'de %79 düzeyinde olan karaciğer transplantasyonu sonrası bir yıllık sağkalım 2008'de %90'a yükselmiştir. Karaciğer transplantasyonlu olguların yoğun bakım yönetiminde özellikle hızlı kardiyorespiratuvar stabilizasyon, ağır koagülopatinin düzeltilmesi, mekanik ventilasyondan erken ayırma, uygun sıvı-elektrolit tedavisi, böbrek fonksiyonlarının korunması, greft rejeksiyonun önlenmesi ve enfeksiyon profilaksisi/tedavisi büyük önem taşır. Erken postoperatif dönem çok hassas bir süreç olduğundan yakın monitörizasyon, kardiyorespiratuvar fonksiyonların stabilizasyonu, greft fonksiyonunun sık değerlendirilmesi, komplikasyonların erken tanınması ve ekstrahepatik organ yetersizliklerinin hızlı tedavisi mortalite/morbiditenin azaltılabilmesi için zorunludur. Anahtar Kelimeler: Karaciğer transplantasyonu, postoperatif dönem, yoğun bakım, karaciğer yetersizliği ABSTRACT Critical care management after liver transplantation requires a sophisticated monitoring and multi-disciplinary team work. An experienced team and advanced critical care/hospital facilities are necessary for an ideal critical care treatment today. Critical care management after liver transplantation has shown a rapid development since the introduction of liver transplantation. While one-year survival rate after liver transplantation was 79% in 1998, it raised to 90% in 2008 related to the improvements in preoperative optimization, surgical technique, anesthetic management, organ preservation, critial care and immunosuppressive treatment. Treatment of severe coagulopathy, prompt hemodynamic and respiratory stabilization, early weaning from mechanical ventilation, proper fluid-electrolyte therapy, prevention of graft rejection, protection of renal functions and prophylaxis/treatment of infection are particularly important in critical care management after liver transplantation. As early postoperative period of liver transplantation is a critical phase; close monitoring, stabilization of cardiopulmonary functions, frequent evaluation of graft function, early diagnosis of complications and rapid treatment of extrahepatic organ failure are mandatory in order to reduce mortality/morbidity.

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“…The other grim side was the lack of high-quality data to support the choice of fluid therapy for resuscitation. In the recent ESICM task force guideline on colloid therapy, seven out of the nine recommendations were based on low quality of evidence and none were based on high quality of evidence [2]. Now this is changing through the publication in 2012 of several randomised trials on fluid therapy [3][4][5].…”

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confidence: 99%

Evidence-based fluid therapy

Perner

Reinhart

2013

Intensive Care Med

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Fluid therapy is one of the most frequent interventions given to hospitalised patients, and one-third of all patients in intensive care units (ICUs) worldwide receive fluid for resuscitation each day [1]. As these patients have considerable mortality rates, any differences in outcome between different types of fluids will have a marked effect on the overall mortality of critically ill patients. Appropriate fluid therapy is therefore likely to improve global health.For decades this has been one side of a difficult dilemma faced by clinicians, guideline committee members and regulatory authorities. The other grim side was the lack of high-quality data to support the choice of fluid therapy for resuscitation. In the recent ESICM task force guideline on colloid therapy, seven out of the nine recommendations were based on low quality of evidence and none were based on high quality of evidence [2]. Now this is changing through the publication in 2012 of several randomised trials on fluid therapy [3][4][5]. Following the well-established track of evidence-based medicine, these trial data are now being added to the cumulated evidence in updated meta-analyses on fluid therapy.In the current issue of Intensive Care Medicine, David Gattas and colleagues present the results of their systematic review and meta-analysis on behalf of the CHEST trial management committee [6]. They have aggregated the data of 35 trials assessing the effect of 6 % hydroxyethyl starch (HES) with molecular weight of 130 and substitution ratio of approximately 0.4 for resuscitation in more than 10,000 acutely ill adults. This is highly relevant, because HES was the most frequently used colloid solution in the latest assessment of fluid resuscitation in ICUs worldwide [1] and 6 % HES130 has for years been the preferred HES solution [7]. The results of the meta-analysis are convincing, as the heterogeneity of the included trial data was low, high numbers of events were analysed for the main outcomes and the trials contributing with most events had crystalloid as comparator and low risk of bias [4,5]. Therefore, the results should, together with those from the recent large trials on 6 % HES130 [4,5], inform clinicians, guideline committees and regulatory authorities.So what did Gattas and colleagues' meta-analysis on 6 % HES130 [1] show? In acutely ill surgical and intensive care patients, fluid resuscitation with 6 % HES130 increased the use of renal replacement therapy [relative risk (RR) in the 6 % HES130 group 1.25, 95 % confidence interval (CI) 1.08-1.44] and mortality (RR 1.08, 95 % CI 1.00-1.17) compared with other fluid solutions. As can be seen, the latter was borderline significant with the lower range of the 95 % CI touching the no-difference point. There are limitations to the systematic review, as the authors did not adhere to all the recommendations from the Cochrane Collaboration. Thus the protocol was not pre-published, only trials that reported specific outcomes were included, authors were not contacted to try and obtain unpublished da...

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Consensus statement of the ESICM task force on colloid volume therapy in critically ill patients

Cited by 231 publications

References 80 publications

Randomised trials of 6 % tetrastarch (hydroxyethyl starch 130/0.4 or 0.42) for severe sepsis reporting mortality: systematic review and meta-analysis

Randomised trials of 6 % tetrastarch (hydroxyethyl starch 130/0.4 or 0.42) for severe sepsis reporting mortality: systematic review and meta-analysis

Critical Care Management after Adult Liver Transplantation

Evidence-based fluid therapy

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