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Intensive Care Medicine
Published in: Intensive Care Medicine 3/2012

01-03-2012 | Special Article

Consensus statement of the ESICM task force on colloid volume therapy in critically ill patients

Authors: Konrad Reinhart, Anders Perner, Charles L. Sprung, Roman Jaeschke, Frederique Schortgen, A. B. Johan Groeneveld, Richard Beale, Christiane S. Hartog

Published in: Intensive Care Medicine | Issue 3/2012

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Abstract

Purpose

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.

Recommendations and 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.
Appendix
Available only for authorised users
Footnotes
1
Increased risk of AKI was defined by a recent consensus conference as advanced age, sepsis, cardiovascular surgery, contrast nephropathy [64].
 
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Metadata
Title
Consensus statement of the ESICM task force on colloid volume therapy in critically ill patients
Authors
Konrad Reinhart
Anders Perner
Charles L. Sprung
Roman Jaeschke
Frederique Schortgen
A. B. Johan Groeneveld
Richard Beale
Christiane S. Hartog
Publication date
01-03-2012
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 3/2012
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-012-2472-9

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