Consensus statement of the ESICM task force on colloid volume therapy in critically ill patients.
OBJECTIVE
Colloids are administered to more patients than crystalloids, although recent evidence suggests that colloids may possibly be harmful in some patients. The European Society of Intensive Care Medicine therefore assembled a task force to compile consensus recommendations based on the current best evidence for the safety and efficacy of the currently most frequently used colloids--hydroxyethyl starches (HES), gelatins and human albumin.


METHODS
Meta-analyses, systematic reviews and clinical studies of colloid use were evaluated for the treatment of volume depletion in mixed intensive care unit (ICU), cardiac surgery, head injury, sepsis and organ donor patients. Clinical endpoints included mortality, kidney function and bleeding. The relevance of concentration and dosage was also assessed. Publications from 1960 until May 2011 were included. The quality of available evidence and strength of recommendations were based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.


CONCLUSIONS
We recommend not to use HES with molecular weight ≥ 200 kDa and/or degree of substitution >0.4 in patients with severe sepsis or risk of acute kidney injury and suggest not to use 6% HES 130/0.4 or gelatin in these populations. We recommend not to use colloids in patients with head injury and not to administer gelatins and HES in organ donors. We suggest not to use hyperoncotic solutions for fluid resuscitation. We conclude and recommend that any new colloid should be introduced into clinical practice only after its patient-important safety parameters are established.
Department for Anesthesiology and Intensive Care Medicine, Jena University Hospital, Friedrich-Schiller University, Erlanger Allee 101, 07747 Jena, Germany. konrad.reinhart@med.uni-jena.de
Konrad
K
Reinhart
Anders
A
Perner
Charles L
CL
Sprung
Roman
R
Jaeschke
Frederique
F
Schortgen
A B
AB
Johan Groeneveld
Richard
R
Beale
Christiane S
CS
Hartog
D002986:Clinical Trials as Topic; D003102:Colloids / Q000009:adverse effects / Q000627:therapeutic use*; D000075202:Contraindications; D016638:Critical Illness / Q000628:therapy*; D019317:Evidence-Based Medicine; D005440:Fluid Therapy / Q000379:methods / Q000592:standards*; D006801:Humans; D015201:Meta-Analysis as Topic; D012196:Review Literature as Topic; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome
D003102:Colloids