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Table 2 HES dose administered and major findings of included randomized trials

From: Systematic review of randomized clinical trials on the use of hydroxyethyl starch for fluid management in sepsis

Trial Days on HES Mean mL·kg-1 HES Major Findings
   Daily Cumulative  
Falk et al., 1988 [9] 1 70.5 70.5 In HES 450/0.7 group PTT increased by 20 s (p = 0.01) and platelet count decreased by 158 × 103 mm-3 (p = 0.01); no significant PTT or platelet count change in albumin group
Rackow et al., 1989 [7] 1 12.9 12.9 FVIII:c declined 45% in the HES 200/0.5 group compared with 5% in the albumin group (p = 0.05)
Boldt et al., 1995 [17,18] 5 8.5 42.3 Plasma thrombomodulin increased in the albumin group and remained unchanged in the HES 200/0.5 group (p < 0.05); plasma protein C among HES 200/0.5 recipients increased on days 4 and 5 without corresponding change in the albumin group (p < 0.05); maximum platelet aggregation declined in both groups (p < 0.05)
Boldt et al., 1996 [19] 5 11.0 55.2 HES 200/0.5 but not albumin increased cardiac index, RVEF, Pao2/Fio2, Do2I and Vo2I and decreased SVRI (p < 0.05 for all comparisons); pHi decreased in albumin but not HES 200/0.5 group (p < 0.05)
Boldt et al., 1996 [20] 5 12.7 63.7 Circulating sELAM-1 and sICAM-1 concentrations reduced by HES 200/0.5 compared with albumin (p < 0.05 for both comparisons)
Boldt et al., 1996 [21] 5 11.0 49.8 Vasopressin, endothelin-1 and norepinephrine decreased and pHi increased in HES 200/0.5 but not albumin group (p < 0.05 for all comparisons); ANP increased by albumin but not HES 200/0.5 (p < 0.05)
Boldt et al., 1998 [22] 5 12.5 62.4 Pao2/Fio2, Do2I and Vo2I increased and lactate decreased by HES 200/0.5 but not albumin (p < 0.05 for all comparisons); no differences in incidence of renal failure, platelet count, PT or aPTT
Asfar et al., 2000 [23] 1 7.9 7.9 Gelatin but not HES 200/0.62 increased pHi (p < 0.001) and decreased CO2 gastric mucosal arterial gradient (p < 0.0005)
Schortgen et al., 2001 [24] 4 14.0 31.0 HES 200/0.62 exposure an independent risk factor for ARF (adjusted odds ratio, 2.57; CI 1.13–5.83)
Molnár et al., 2004 [25] 1 14.3 14.3 No differences detected in ITBVI, EVLW or Pao2/Fio2
Palumbo et al., 2006 [26] 5 --§ --§ Target PCWP of 15–18 mm Hg maintained by both colloids; temperature, MAP, PAP, CVP, heart rate and urine output remained stable without differences between groups; HES 130/0.4, but not albumin, increased cardiac index and several oxygenation parameters (Pao2/Fio2, Do2I and Vo2I) and decreased APACHE II score (p < 0.05 for all within-group comparisons)
Brunkhorst et al., 2008 [27] 21 --§ 70.4 Greater ARF incidence in HES 200/0.5 group (odds ratio, 1.81; CI, 1.22–2.71; p = 0.002); increased mortality at higher HES 200/0.5 doses (odds ratio, 3.08; CI, 1.78–5.37; p < 0.001)
  1. Abbreviations: ANP, atrial natriuretic peptide; APACHE, Acute Physiology and Chronic Health Evaluation; aPTT, activated partial thromboplastin time; ARF, acute renal failure; CI, 95% confidence interval; CVP, central venous pressure; Do2I, oxygen delivery index; EVLW, extravascular lung water; HES, hydroxyethyl starch; FVIII:c, factor VIII coagulant activity; ITBVI, intrathoracic blood volume index; MAP, mean arterial pressure; Pao2/Fio2, ratio of partial pressure of arterial oxygen to fraction of inspired oxygen; PAP, pulmonary artery pressure; PCWP, pulmonary capillary wedge pressure; pHi, gastric intramucosal pH; PT, prothrombin time; PTT, partial thromboplastin time; RVEF, right ventricular ejection fraction; sELAM-1, soluble endothelial leucocyte adhesion molecule-1; sICAM-1, soluble intercellular adhesion molecule-1; SVRI, systemic vascular resistance index; Vo2I, oxygen consumption index
  2. Calculated from reported volume administered assuming 70 kg body weight.
  3. Actual days on HES not specified. Maximum of 4 days imposed after start of study, and percentage of patients receiving HES longer not indicated. Daily dose stated for day 1 only. Cumulative dose reported as median.
  4. §Not reported.
  5. Median.