Table 1.
Characteristics of included randomized trials
| Trial | n† | Indication | Fluid Regimen‡ | Follow-Up | Endpoints |
| Falk et al., 1988 [9] | 12 | Septic shock | 6% HES 450/0.7 or 5% albumin to 15 mm Hg target PAWP | 24 h | Coagulation |
| Rackow et al., 1989 [7] | 20 | Severe sepsis and systemic hypoperfusion | 10% HES 200/0.5 or 5% albumin to 15 mm Hg target PAWP or 2000 mL maximum | 45 min | Cardiorespiratory function and coagulation |
| Boldt et al., 1995 [17,18] | 30 | Sepsis after major surgery | 10% HES 200/0.5 or 20% albumin to 12–16 mm Hg target CVP, PCWP or both | 5 days | Endothelial-related coagulation and platelet function |
| Boldt et al., 1996 [19] | 30 | Sepsis secondary to major general surgery | 10% HES 200/0.5 or 20% albumin to 12–18 mm Hg target PCWP | 5 days | Cardiorespiratory and circulatory variables |
| Boldt et al., 1996 [20] | 42 | Sepsis secondary to major surgery | 6% HES 200/0.5, 20% albumin or pentoxifylline | 5 days | Circulating soluble adhesion molecules |
| Boldt et al., 1996 [21] | 28 | Sepsis secondary to major surgery | 10% HES 200/0.5 or 20% albumin to 10–15 mm Hg target PCWP | 5 days | Circulatory variables |
| Boldt et al., 1998 [22] | 150 | Postoperative sepsis | 10% HES 200/0.5 or 20% albumin to 12–15 mm Hg target PCWP | 5 days | Hemodynamics, laboratory data and organ function |
| Asfar et al., 2000 [23] | 34 | Sepsis and hypovolemia in ventilated and hemodynamically controlled patients | 500 mL 6% HES 200/0.62 or 4% succinylated modified fluid gelatin | 60 min | Hemodynamics and gastric mucosal acidosis |
| Schortgen et al., 2001 [24] | 129 | Severe sepsis or septic shock | 6% HES 200/0.62 up to 4 days or 80 mL·kg-1 cumulative dose or 3% gelatin | 34 days | ARF |
| Molnár et al., 2004 [25] | 30 | Septic shock with hypovolemia and acute lung injury | 6% HES 200/0.5 or 4% modified fluid gelatin to achieve ITBVI > 900 mL·m-2 | 60 min | Hemodynamics, EVLW and oxygenation |
| Palumbo et al., 2006 [26] | 20 | Severe sepsis in mechanically ventilated patients | 6% HES 130/0.4 or 20% albumin to maintain PCWP of 15–18 mm Hg | 5 days | Hemodynamic and oxygenation parameters |
| Brunkhorst et al., 2008 [27] | 537 | Severe sepsis or septic shock | 10% HES 200/0.5 (to 20 mL·kg-1·day-1 limit) or Ringer's lactate to target of ≥ 8 mm Hg CVP | 90 days | Morbidity and mortality |
Abbreviations: ARF, acute renal failure; CVP, central venous pressure; EVLW, extravascular lung water; HES, hydroxyethyl starch; ICU, intensive care unit; ITBVI, intrathoracic blood volume index; PAWP, pulmonary arterial wedge pressure; PCWP, pulmonary capillary wedge pressure
†For trials with more than one indication, includes only patients with sepsis.
‡HES solutions specified by molecular weight/molar substitution.