Retractions Lead to Revision of Review Article “Contemporary Fluid Management in Cardiac Anesthesia”

Abstract

Numerous articles authored by Dr Joachim Boldt were retracted from international journals on anesthesia and intensive care medicine because of missing institutional review board approvals. Therefore, we believe our recent publication1Habicher M. Perrino Jr, A. Spies C.D. et al.Contemporary fluid management in cardiac anesthesia.J Cardiothorac Vasc Anesth. 2011; 25: 1141-1153Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar needed to be updated to re-evaluate conclusions that might have been influenced by the retracted data. Our review cited 5 articles by Dr Boldt.2Boldt J. Lenz M. Kumle B. et al.Volume replacement strategies on intensive care units: Results from a postal survey.Intensive Care Med. 1998; 24: 147-151Crossref PubMed Scopus (118) Google Scholar, 3Boldt J. Haisch G. Suttner S. et al.Effects of a new modified, balanced hydroxyethyl starch preparation (Hextend) on measures of coagulation.Br J Anaesth. 2002; 89: 722-728Crossref PubMed Scopus (99) Google Scholar, 4Boldt J. PRO: Hydroxyethyl starch can be safely used in the intensive care patient—The renal debate.Intensive Care Med. 2009; 35: 1331-1336Crossref PubMed Scopus (27) Google Scholar, 5Boldt J. Brenner T. Lehmann A. et al.Influence of two different volume replacement regimens on renal function in elderly patients undergoing cardiac surgery: Comparison of a new starch preparation with gelatin.Intensive Care Med. 2003; 29: 763-769Crossref PubMed Scopus (91) Google Scholar, 6Boldt J. Brosch Ch. Röhm K. et al.Comparison of the effects of gelatin and a modern hydroxyethyl starch solution on renal function and inflammatory response in elderly cardiac surgery patients.Br J Anaesth. 2008; 100: 457-464Crossref PubMed Scopus (76) Google Scholar Three of these 5 publications are among the articles that were retracted.3Boldt J. Haisch G. Suttner S. et al.Effects of a new modified, balanced hydroxyethyl starch preparation (Hextend) on measures of coagulation.Br J Anaesth. 2002; 89: 722-728Crossref PubMed Scopus (99) Google Scholar, 5Boldt J. Brenner T. Lehmann A. et al.Influence of two different volume replacement regimens on renal function in elderly patients undergoing cardiac surgery: Comparison of a new starch preparation with gelatin.Intensive Care Med. 2003; 29: 763-769Crossref PubMed Scopus (91) Google Scholar, 6Boldt J. Brosch Ch. Röhm K. et al.Comparison of the effects of gelatin and a modern hydroxyethyl starch solution on renal function and inflammatory response in elderly cardiac surgery patients.Br J Anaesth. 2008; 100: 457-464Crossref PubMed Scopus (76) Google Scholar After discussion within our group, we decided to remove all sentences and paragraphs discussing these publications by Dr Boldt to counter the argument that any conclusion drawn in this review article could have been influenced by possibly fraudulent data. In particular, the section “Colloids and Renal Function in Cardiac Surgery” is a concern because the 2 prospective randomized trials addressing this issue were authored by Dr Boldt and are among the retracted articles. We removed the discussion of the articles by Dr Boldt and discussed data from related surgical specialties because, to the best of our knowledge, no other studies investigating the effect of colloids on renal function in cardiac surgery are available. The conclusions drawn are different from the original article because no recommendations on the safe use of starch solutions regarding renal function in cardiac surgical patients, regardless of the generation of starches used, can be made. The entire discussion of the issue concerning Dr Boldt emphasizes that the gap of knowledge regarding the safety of colloid solutions and especially the impact on renal function in cardiac surgery needs to be addressed by sufficiently powered, prospective, randomized trials. Contemporary Fluid Management in Cardiac AnesthesiaJournal of Cardiothoracic and Vascular AnesthesiaVol. 25Issue 6PreviewTHE PRESCRIPTION OF perioperative fluids has been a persistent controversy among anesthesiologists, surgeons, and intensivists. Interestingly, disagreements within each specialty as to the appropriate types and amounts of fluids required are just as intense as that seen among the specialties. The challenge in navigating these waters is demanding because the safe harbor of optimal fluid administration is bounded by hypovolemia and end-organ hypoperfusion (resulting from inadequate fluids) and congestive heart failure and the negative effects of edema formation on respiration and wound healing (resulting from excessive fluids). Full-Text PDF