We thank Dr Colomina and colleagues1 for their letter and are encouraged that their findings and guidelines1,2 concur with ours. As acknowledged in our study,3 a limitation was the inclusion of some older studies into our meta-analysis. These used older generation hydroxyethyl starches that may behave differently. As per our study design, we did not include studies performed in cardiac surgery, and this is one of the main differences between our meta-analysis and others previously published.
The evidence base for perioperative fluid choice remains poor, with both the benefit and safety of synthetic colloids still to be shown in the perioperative setting. There is a similar paucity in the literature to substantiate safety or support any significant benefit with fluid resuscitation with gelatins. A 2011 meta-analysis of 40 randomised controlled trials with 3275 patients concluded that ‘the safety and efficacy of gelatin cannot be reliably assessed’.4 Twenty-nine of these trials (n = 2001 patients) were in the elective surgical population.
Until we have better evidence on which to base practice, we agree that balanced crystalloid solutions should be the basis of perioperative fluid replacement therapy. Balanced third-generation synthetic starches can be considered in patients refractory to crystalloids who have no risk factors or contraindications.
Acknowledgements relating to this article
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Conflicts of interest: none.
1. Colomina MJ, Basora M, Moral V, Llau JV. Crystalloids and hydroxyethyl starches in noncardiac surgical patients. Eur J Anaesthesiol
2. Basora M, Colomina MJ, Moral V, et al. Clinical practice guide for the choice of perioperative volume-restoring fluid in adult patients undergoing noncardiac surgery. Rev Esp Anestesiol Reanim
3. Raiman M, Mitchell CG, Biccard BM, et al. Comparison of hydroxyethylstarch colloids with crystalloids for surgical patients: a systematic review and meta-analysis. Eur J Anaesthesiol
4. Thomas-Rueddel DO, Vlasakov V, Reinhart K, et al. Safety of gelatin for volume resuscitation: a systematic review and meta-analysis. Intensive Care Med