title: Hydroxyethyl starch versus other fluids for non-septic patients in the intensive care unit: a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Use of hydroxyethyl starch (HES) in septic patients is reported to increase the mortality and incidence of renal replacement therapy (RRT). However, whether or not use of HES would induce the same result in non-septic patients in the intensive care unit (ICU) remains unclear. The objective of this meta-analysis was to evaluate 6% HES versus other fluids for non-septic ICU patients.
  
  
  METHODS
  Randomized controlled trials (RCTs) were searched from Pubmed, OvidSP, Embase database and Cochrane Library, published before November, 2013. A meta-analysis was made on the effect of 6% HES versus other fluids for non-septic ICU patients, including mortality, RRT incidence, bleeding volume, red blood cell (RBC) transfusion and fluid application for non-septic patients in ICU.
  
  
  RESULTS
  Twenty-two RCTs were included, involving 6,064 non-septic ICU patients. Compared with the other fluids, 6% HES was not associated with decreased overall mortality (RR = 1.03, 95%CI: 0.09 to 1.17; P = 0.67; I(2) = 0). There was no significant difference in RRT incidence, bleeding volume and red blood cell transfusion between 6% HES group and the other fluid groups. However, patients in HES group received less total intravenous fluids than those receiving crystalloids during the first day in ICU (SMD = -0.84; 95%CI: -1.39 to -0.30; P = 0.003, I(2) = 74%).
  
  
  CONCLUSIONS
  This meta-analysis found no increased mortality, RRT incidence, bleeding volumes or RBC transfusion in non-septic ICU patients, but the sample sizes were small and the studies generally were of poor quality.
authors.affiliation: Department of Anesthesiology and SICU, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, Kongjiang Road 1665, Shanghai, 200092, China. hebinicu@139.com.
authors.forename: Bin
authors.initials: B
authors.lastname: He
authors.affiliation: Department of Anesthesiology and SICU, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, Kongjiang Road 1665, Shanghai, 200092, China. xubo-mazui@163.com.
authors.forename: Bo
authors.initials: B
authors.lastname: Xu
authors.affiliation: Department of Epidemiology, Shanghai Jiaotong University, School of Medicine, Kongjiang Road 1665, Shanghai, 200092, China. xiaoxingxu1@sina.com.
authors.forename: Xiaoxing
authors.initials: X
authors.lastname: Xu
authors.affiliation: Pharmaceutical Department, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, Kongjiang Road 1665, Shanghai, 200092, China. llxlyy88@sina.com.
authors.forename: Lixia
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Anesthesiology and SICU, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, Kongjiang Road 1665, Shanghai, 200092, China. lingximengfei@126.com.
authors.forename: Rongrong
authors.initials: R
authors.lastname: Ren
authors.affiliation: Department of Anesthesiology and SICU, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, Kongjiang Road 1665, Shanghai, 200092, China. caterchenzy@hotmail.com.
authors.forename: Zhiyu
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery, Second Military Medical University, Fengyang Road 415, Shanghai, 200003, China. xiaoj@189.cn.
authors.forename: Jian
authors.initials: J
authors.lastname: Xiao
authors.affiliation: Department of Anesthesiology and SICU, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, Kongjiang Road 1665, Shanghai, 200092, China. docwangyw@sina.com.
authors.forename: Yingwei
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery, Shanghai Tenth People's Hospital, Tongji University, School of Medicine, Yanchang Road 301, Shanghai, 200072, China. pfdbsxubin@163.com.
authors.forename: Bin
authors.initials: B
authors.lastname: Xu
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced; D000077324:Crystalloid Solutions; D005440:Fluid Therapy; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects* / Q000627:therapeutic use; D007362:Intensive Care Units; D007552:Isotonic Solutions / Q000008:administration & dosage; D010952:Plasma Substitutes / Q000008:administration & dosage / Q000009:adverse effects*; D016032:Randomized Controlled Trials as Topic; D017582:Renal Replacement Therapy; D018805:Sepsis
chemical_list: D000077324:Crystalloid Solutions; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes