A Dubin

A Godier

A Perner

AA Schramko

AG Sawyer

AJ Onwuegbuzie

Amit Patel

B Guidet

C Ertmer

C Sirtl

CJ Wiedermann

CL Sprung

Committee TCvHSTCM

CS Hartog

D Moher

D Palumbo

DJ Cook

DJ Gattas

F Li

F Schortgen

FM Brunkhorst

FS Investigators

GC Zhu

H Sahai

I Roten von

J Cohen

J Lv

JA Freiman

JA Myburgh

JA Russell

JL Vincent

JP Higgins

K Reinhart

M Dolecek

M Jacob

M Schmidt-Hieber

M Sossdorf

P Matsota

R Bellmann

R Bellomo

R DerSimonian

RP Dellinger

S Finfer

S Stander

SA Kozek-Langenecker

SH Sahin

SL Shafer

SM Kasper

Stephen J. Brett

T Niemi

TA Neff

Umeer Waheed

VG Nielsen

VM Ranieri

WA Knaus

English

Crossref

Intensive Care Medicine

Randomised trials of 6 % tetrastarch (hydroxyethyl starch 130/0.4 or 0.42) for severe sepsis reporting mortality: systematic review and meta-analysis

14.03.13 KB. Ok to add accepted version to spiral. SpringerPurpose
To assess the impact of 6 % tetrastarch [hydroxyethyl starch (HES) 130/0.4 and 130/0.42] in severe sepsis patients. The primary outcome measure was 90-day mortality.
Methods
A structured literature search was undertaken to identify prospective randomised controlled trials (RCTs) in adult patients with severe sepsis receiving 6 % tetrastarch (of potato or waxy maize origin) as part of fluid resuscitation in comparison with other non-HES fluids after randomisation in the critical care setting. A systematic review and meta-analysis were performed.
Results
Six RCTs were included (n = 3,033): three from 2012 (n = 2,913) had low risk of bias. Median tetrastarch exposure was 37.4 ml/kg (range 30–43 ml/kg). Ninety-day mortality was associated with tetrastarch exposure [relative risk (RR) 1.13; 95 % confidence interval (CI) 1.02–1.25; p = 0.02] compared with crystalloid. The number needed to harm (NNH) was 28.8 (95 % CI 14.6–942.5). Publication bias and statistical heterogeneity (I 2 = 0 %) were not present. Tetrastarch exposure was also associated with renal replacement therapy (p = 0.01; NNH 15.7) and allogeneic transfusion support (p = 0.001; NNH 9.9). No difference between groups was observed for 28-day mortality, for comparison with colloid as control, or for waxy maize-derived tetrastarch, but power was lacking. Overall mortality was associated with tetrastarch exposure (RR 1.13; 95 % CI 1.02–1.25; p = 0.02).
Conclusions
In our analysis, 6 % tetrastarch as part of initial fluid resuscitation for severe sepsis was associated with harm and, as alternatives exist, in our view should be avoided

Patel, A

Waheed, U

Brett, SJ

Spiral - Imperial College Digital Repository

0.9% NaCl fluid replacement in patients with severe sepsis: The CRYSTMAS study. Crit Care 16: R94 27. Cohen

6% tetrastarch Control fluid RCT Management protocol Age Male Sex (%) SOFA or APACHE II Shock or vasopressor (%) Age Male Sex (%) SOFA or APACHE II Shock or vasopressor (%) Dolecek et al. 2009[41] Surviving Sepsis guidelines[31] 43

Resuscitation fluid use in critically ill adults: an international cross-sectional study in 391 intensive care units. Crit Care 14: R185 2. Investigators FS, Trials SCC,

Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society 97: 259-265 21. Schramko

Should unpublished data be included in metaanalyses? Current convictions and controversies. JAMA : the journal of the

Randomised trials of 6 % tetrastarch (hydroxyethyl starch 130/0.4 or 0.42) for severe sepsis reporting mortality: systematic review and meta-analysis

http://spiral.imperial.ac.uk/bitstream/10044/1/10683/8/Patel%20et%20al%20Meta-analysis%20tetrastarch%20-%20repository%20version.pdf

Randomised trials of 6 % tetrastarch (hydroxyethyl starch 130/0.4 or 0.42) for severe sepsis reporting mortality: systematic review and meta-analysis.

Randomised trials of 6 % tetrastarch (hydroxyethyl starch 130/0.4 or 0.42) for severe sepsis reporting mortality: systematic review and meta-analysis.

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Spiral - Imperial College Digital Repository