Twelve RCTs (n=1,062) were included, all published.
HES 130/0.4 and HES 200/0.5 significantly improved haemodynamic and cardiorespiratory variables (p<0.05); 20 per cent albumin did not (three RCTs). HES 200/0.5 significantly improved Acute Physiology and Chronic Health Evaluation II score (one RCT), improved gastric intramucosal pH (pHi) (one RCT) and avoided a decline in pHi (one RCT) (all p<0.05); 20 per cent albumin did not.
No differences were detected in haemodynamic and cardiorespiratory variables when HES 200/0.5 and gelatin were compared (one RCT). Gelatin significantly decreased gastric mucosal arterial gradient (p<0.0005) and raised pHi (p<0.001); HES 200.0/62 did not (one RCT).
HES 450/0.7 significantly impaired coagulation (prolonged partial thromboplastin time and decreased platelet count, p=0.01); 5 per cent albumin did not (one RCT). One RCT reported no difference in coagulation and platelet count between HES 200/0.5 and 20 per cent albumin. HES 200/0.5 was significantly associated with diminished factor VIII levels compared with 5 per cent albumin (p=0.05, one RCT) and impaired coagulation compared to crystalloid (p<0.001, one RCT).
Longer term effects
HES 200/0.62 was associated with a significantly higher incidence of renal failure over 34-day follow up than gelatin (OR 2.57, 95% CI: 1.13, 5.83, p=0.018, one RCT, n=129). In a second RCT (n=537), over 90-day follow up HES 200/0.5 was significantly associated with impaired renal function (p=0.02) and a higher incidence of ARF (OR 1.81, 95% CI: 1.22, 2.71, p=0.002) and use of renal replacement therapy (RRT) (OR 1.95, 95% CI: 1.23, 2.98, p=0.001) than crystalloid. RRT use significantly correlated with cumulative HES dose (p<0.001). There was a trend to higher 90-day mortality in the HES group (OR 1.35, 95% CI: 0.94, 1.95, p=0.11). Mortality was significantly higher among patients receiving a higher dose of HES (more than 22 mLs/kg for at least one day) than among those receiving a lower dose (p<0.001).