title: [The role of colloids in intensive care medicine. Evidence instead of emotions].
abstract: BACKGROUND
  Besides albumin, which is gained from human donors, synthetic colloids have been playing a dominant role in treating patients in shock and are standard therapy in intensive care units (ICU). Since the publication of large randomized controlled trials indicating negative effects on renal function, their use has been questioned, especially for hydroxyethyl starch products. The preliminary assumption that these side effects are only existent in first or secondary generation starch fluids was proven incorrect. In fact, the use of hydroxyethyl starch products in critically ill patients is prohibited by the European Medicines Agency.
  Several methodological limitations exist in each of these trials that limit the evidence value of these investigations, although they served as the basis for the negative judgment of the European Medicines Agency. In addition, a large randomized controlled trial on the efficacy of gelatin is lacking. The use of colloids in ICU patients is indicated in cases where crystalloid volume therapy is inadequate.
  
  
  CONCLUSIONS
  Especially during the first 6 h of sepsis, when aggressive volume therapy is decisive for patient outcome, colloids may be relevant to increase patient survival. The latest guideline on treatment with colloids has been published in the German S3 guideline "Intravascular volume therapy in adults."
authors.affiliation: Klinik für operative Intensivmedizin und Intermediate Care, Universitätsklinik der RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland, cbruells@ukaachen.de.
authors.forename: C S
authors.initials: CS
authors.lastname: Bruells
authors.forename: A
authors.initials: A
authors.lastname: Schindler
authors.forename: G
authors.initials: G
authors.lastname: Marx
mesh_terms: D000328:Adult; D000418:Albumins / Q000008:administration & dosage / Q000009:adverse effects; D003102:Colloids / Q000008:administration & dosage* / Q000009:adverse effects; D003422:Critical Care / Q000379:methods* / Q000523:psychology*; D061345:Early Medical Intervention; D004644:Emotions; D019317:Evidence-Based Medicine; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods*; D005780:Gelatin / Q000008:administration & dosage / Q000009:adverse effects; D019983:Guideline Adherence; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives; D018805:Sepsis / Q000628:therapy
chemical_list: D000418:Albumins; D003102:Colloids; D006895:Hydroxyethyl Starch Derivatives; D005780:Gelatin