Evidence-based medicine: Do we need gelatins and starches?

Abstract

For more than a decade, systematic reviews have questioned the value of colloids in fluid resuscitation. A Cochrane review that was updated in early 2012 found no mortality advantage relative to crystalloids across a range of conditions for gelatins [risk ratio (RR) 0.91, 95% confidence interval (CI): 0.49–1.72], albumin (RR 1.01, 95% CI: 0.93–1.10), or hydroxyethyl starch (RR 1.10, 95% CI: 0.91–1.32.) Subsequent to that review, two further high-quality randomised controlled trials [Crystalloid vs Hydroxyethyl Starch Trial (CHEST) and Scandinavian Starch for Severe Sepsis/Septic Shock (6S) trial also failed to demonstrate a mortality benefit and raised concerns about renal harm.