Abstract
The purpose of this study was to investigate the efficacy and safety of synthetic colloid resuscitation among severely injured patients. Fluid resuscitation of trauma patients of a nationwide trauma registry was analysed between 2002 and 2015. Effects of synthetic colloid resuscitation in the pre-hospital setting and emergency department on renal failure, renal replacement therapy and multiple organ failure were analysed among patients with ≥2 days intensive care unit stay, and in-hospital mortality was analysed among all patients. 48,484 patients with mean age of 49 years and mean injury severity score of 23 points were included; 72.3% were male and 95.5% had blunt trauma. Risk-adjusted analyses revealed that patients receiving >1,000 ml synthetic colloids experienced an increase of renal failure and renal replacement therapy rates (OR 1.42 and 1.32, respectively, both p ≤ 0.006). Any synthetic colloid use was associated with an increased risk of multiple organ failure (p < 0.001), but there was no effect on hospital mortality (p = 0.594). Between 2002 and 2015 usage of synthetic colloids dropped, likewise did total fluid intake and usage of blood products. The data from this analysis suggests that synthetic colloid resuscitation provides no beneficial effects and might be harmful in patients with severe trauma.
Highlights
Synthetic colloid infusion solutions have been developed to increase haemodynamic stabilization effectively and economically
199,977 patients were recorded in the TraumaRegister DGU (TR-DGU) database
The main findings of this analysis of early fluid resuscitation in severely injured patients from a nationwide trauma registry show that synthetic colloid resuscitation of more than 1,000 ml was associated with an increased need for renal replacement therapy and synthetic colloid use at any dose was associated with an increased incidence of multiple organ dysfunction
Summary
Synthetic colloid infusion solutions have been developed to increase haemodynamic stabilization effectively and economically. A second assessment committee confirmed that HES solutions must not be used in critically ill patients or those with sepsis and burn injuries but allowed their continued use in patients with hypovolaemia due to acute blood loss within the first 24 hours after elective surgery or trauma[5]. The EMA committee requested large randomised post-marketing clinical trials from HES manufacturers to establish the efficacy and safety of HES in perioperative and trauma populations[16,17]. The aim of this retrospective registry study was to further elucidate the risk benefit ratio of synthetic colloids in a large registry that comprises severely injured patients
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