Comments on Reinhart et al.: consensus statement of the ESICM task force on colloid volume therapy in critically ill patients.

Dear Editor,

We are grateful that a task force has addressed colloid volume therapy in critically ill patients [1]. This issue is currently the focus of considerable debate, and new data from ongoing trials can be expected in the new future.

A task force is considered to be a group of specialists who have been appointed to work together on a temporary basis with the specific aim to provide an answer to a specific question. In this respect, the consensus statement of the European Society of Intensive Care Medicine’s task force on colloid volume replacement in critically ill patients immediately raises two questions: what is the basis on which the task force was selected? Which entity initiated this initiative? The methodology of the article does not provide any information on these points, and the reader is left with some degree of doubt on how the individual members of the “task force” were selected. Eight individuals (“the eight panel members”) apparently voted on each aspect of the statement. However, it seems highly questionable whether a small group of only eight individuals are capable of representing a true consensus of the various opinions among experts in the field in Europe—particularly when the group included two authors from the same department, representing 25 % of the votes.

Our concern is not whether the statement is correct or incorrect, but rather whether the approach used to establish the consensus was the most suitable one and whether it was capable of representing the opinions of intensivists throughout Europe—particularly since current data on the topic are limited, and several trials currently in progress are likely to provide new data in the very near future. Was the methodology for drawing up guidelines on best medical practices—as recommended by the European Health Committee (Comité Européen de la Santé, CDSP) and adopted by the Committee of Ministers of the Council of Europe in 2001 [2]—followed during the review process and publication of the statement?

It is therefore very surprising that such an important statement was apparently accepted for publication by Intensive Care Medicine within 2 days of submission (as specified on p. 368). In the absence of any information on how the present recommendations were evaluated, the reader can only speculate on the peer review process regarding this consensus statement. Are these recommendations supported by the majority of European intensive care specialists or do they merely reflect the “expert opinion” of eight authors?

Here, we suggest that these points need to be clarified. In future comparable cases, we would also recommend that such statements should be based on the input of representatives of all of the disciplines involved in critical care medicine (surgery, anesthesia, internal medicine, neurology, physiology, etc.). Such an approach, based on a comprehensible procedure, is currently being used in Germany to develop a guideline on intravascular volume therapy in adults, in accordance with the guidelines of the Working Group of Scientific Medical Specialist Societies (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF) [3].