CARING FOR THE CRITICALLY ILL PATIENT Association of Hydroxyethyl Starch Administration With Mortality and Acute Kidney Injury in Critically Ill Patients Requiring Volume Resuscitation A Systematic Review and Meta-analysis

FLUIDS ARE A CORE ELEMENT IN the resuscitation of critically ill patients and the relative superiority and safety of different resuscitation solutions has been the focus of considerable debate. Crystalloid solutions are inexpensive and readily available, while colloid solutions may minimize resuscitation volumes, and may sustain intravascular volume for longer durations. Conflicting results from clinical trials and systematic reviews have not resolved this debate, leaving clinicians to select resuscitation fluids based on suboptimal evidence. Hydroxyethyl starch is a synthetic colloid derived from partially hydrolyzed and variably hydroxyethylated plant starch, and is commonly administered to patients requiring fluid resuscitation. Clinical trials and systematic reviews have suggested a greater incidence of renal damage and mortality in patients receiving hydroxyethyl starch, but these findings have been inconsistent. The differing results may be due to a combination of factors including differing patient populations,