Authors

Guidet et al (2012)

Methodology
CRYSTMAS study Double-blind, multicentre prospective randomised controlled trial. HES vs. NaCl in severe sepsis.
SAFE study Double-blind, multicentre randomised controlled. 4% Albumin vs. NaCl of patients in ICUs. VISEP study Randomised multicentre, two-by-two factorial trial. HES vs. Ringers Lactate (Hartmann's) in severe sepsis. FIRST study Double-blind randomised controlled trial. HES vs. NaCl in severe trauma. Single blinded prospective randomised controlled trial. 4 types of fluids & their affects on pulmonary permeability & oedema. FINESS study Randomised pilot feasibility multicentre trial HES vs. NaCl in septic shock.

Intervention
88 HES group
86 NaCl group

Findings

Limitations

HES had no clinical impact on coagulation compared to NaCl group. Mortality rate was slightly higher in HES group both at day 28 & 90.

Fluid responsiveness was not assessed & CVP not used as an indicator either. Kidney function was not part of the final criteria .

Finfer et al (2004)

3497 Albumin group 3500 NaCl group 262 HES group 275 Ringers Lactate group

Both groups had similar mortality outcomes at 28 days suggesting albumin is a safe alternative. Albumin group received /needed less fluid during the first 4 days but required more RBCs during the first 2 days . Stopped early due to much higher incidence of acute renal failure in HES group. HES recipients had a significantly lower platelet count and received more units of RBCs. The higher dose of HES the greater chance of mortality. In penetrating trauma, HES provided signicantly better lactate clearance and less renal injury than NaCl. Huge number of patients excluded due to the restricting criteria. Showed that the type of fluid had no affect on pulmonary oedema or severity of lung injury. Less fluid was needed in the colloid groups to reach cardiovascular stability.

Due to the size of the trial quite a few errors were made pts being randomised more than once, clinicians giving other fluids than the 2 agreed groups, details being lost . 2 trials running at the same time so results may not be as clear cut. (Insulin therapy) Mentioned coagulation issues with HES but provided no detailed evidence. Trauma patients not septic patients. Trial ended early due to fewer referrals unable to meet target figure. Small trial. Mortality was not even noted let alone mentioned after discharge, 28 or 90 days.

Brunkhost et al (2008)

James et al (2011)

58 HES group 57 NaCl group

Heijden et al (2009)

36 Colloid group 12 Crystalloid group

McIntyre et al (2008)

21 HES group 19 NaCl group

Vasoactive drugs were more frequently used in the HES group compared to NaCl group. The VISEP trial showed a higher mortality & increased incidence of acute renal failure when using HES as a resuscitation fluid so this feasibility trial was stopped.

Small test pilot size trial. High exclusion main reason due to pt receiving too much fluid prior to randomisation.