Abstract
You have recently heard reports that synthetic colloids may be associated with renal failure and other morbidities in certain populations of critically ill patients. You have been asked by the hospital chief of staff whether there should be a suspension of the use of synthetic colloids until further information is available. You need to make a decision.
Highlights
Colloid solutions are commonly used to replenish or maintain intravascular volume status in a variety of clinical settings
Schortgen and colleagues [16] randomly assigned 129 patients to receive either hydroxyethyl starches (HESs) 200/0.62 or 3% gelatin for intravascular volume expansion and followed them for 34 days. They found that the HES group had a significantly higher incidence of acute renal failure (ARF), and in a multivariate analysis, the use of HES was associated with an odds ratio of 2.57 for ARF
We cannot support a comprehensive ban on synthetic colloids on the basis of only two trials [16,17] but these two trials represent the best evidence currently available
Summary
Colloid solutions are commonly used to replenish or maintain intravascular volume status in a variety of clinical settings. In the more recent VISEP (Efficacy of Volume Substitution and Insulin Therapy in Severe Sepsis) study, Brunkhorst and colleagues [17] randomly assigned 537 patients with severe sepsis or septic shock to receive either HES 200/0.5 or Ringer lactate as part of a 96-hour protocol to maintain a central venous pressure of greater than 8 mm Hg, a central venous O2 saturation of greater than 70%, and a mean arterial pressure of greater than 70 mm Hg. Again, patients in the HES group had a higher incidence of renal failure requiring dialysis (31.0% versus 18.8%; P = 0.001). A study comparing a ‘balanced’ and ‘unbalanced’ HES solution in patients undergoing abdominal surgery demonstrated no difference, with no renal dysfunction or coagulopathy in either group [6]. A recent study evaluated renal effects in 33 patients with pre-existing mild renal dysfunction who were randomly assigned to receive 6% HES (130/0.4) or gelatin (in addition to at least 1.5 L/day crystalloid) for perioperative volume replacement for abdominal aortic surgery [37]. They should not serve as the basis of a comprehensive ban on synthetic colloids in any patient population
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