Hydroxyethyl starch or saline for fluid resuscitation in intensive care.
BACKGROUND
The safety and efficacy of hydroxyethyl starch (HES) for fluid resuscitation have not been fully evaluated, and adverse effects of HES on survival and renal function have been reported.


METHODS
We randomly assigned 7000 patients who had been admitted to an intensive care unit (ICU) in a 1:1 ratio to receive either 6% HES with a molecular weight of 130 kD and a molar substitution ratio of 0.4 (130/0.4, Voluven) in 0.9% sodium chloride or 0.9% sodium chloride (saline) for all fluid resuscitation until ICU discharge, death, or 90 days after randomization. The primary outcome was death within 90 days. Secondary outcomes included acute kidney injury and failure and treatment with renal-replacement therapy.


RESULTS
A total of 597 of 3315 patients (18.0%) in the HES group and 566 of 3336 (17.0%) in the saline group died (relative risk in the HES group, 1.06; 95% confidence interval [CI], 0.96 to 1.18; P=0.26). There was no significant difference in mortality in six predefined subgroups. Renal-replacement therapy was used in 235 of 3352 patients (7.0%) in the HES group and 196 of 3375 (5.8%) in the saline group (relative risk, 1.21; 95% CI, 1.00 to 1.45; P=0.04). In the HES and saline groups, renal injury occurred in 34.6% and 38.0% of patients, respectively (P=0.005), and renal failure occurred in 10.4% and 9.2% of patients, respectively (P=0.12). HES was associated with significantly more adverse events (5.3% vs. 2.8%, P<0.001).


CONCLUSIONS
In patients in the ICU, there was no significant difference in 90-day mortality between patients resuscitated with 6% HES (130/0.4) or saline. However, more patients who received resuscitation with HES were treated with renal-replacement therapy. (Funded by the National Health and Medical Research Council of Australia and others; CHEST ClinicalTrials.gov number, NCT00935168.).
Division of Critical Care and Trauma, George Institute for Global Health, Sydney, NSW, Australia. jmyburgh@georgeinstitute.org.au
John A
JA
Myburgh
Simon
S
Finfer
Rinaldo
R
Bellomo
Laurent
L
Billot
Alan
A
Cass
David
D
Gattas
Parisa
P
Glass
Jeffrey
J
Lipman
Bette
B
Liu
Colin
C
McArthur
Shay
S
McGuinness
Dorrilyn
D
Rajbhandari
Colman B
CB
Taylor
Steven A R
SA
Webb
D000328:Adult; D000368:Aged; D003404:Creatinine / Q000097:blood / Q000652:urine; D003422:Critical Care; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects / Q000627:therapeutic use*; D007362:Intensive Care Units; D057194:Intention to Treat Analysis; D007674:Kidney Diseases / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012151:Resuscitation / Q000379:methods; D012965:Sodium Chloride / Q000627:therapeutic use
D006895:Hydroxyethyl Starch Derivatives; D012965:Sodium Chloride; D003404:Creatinine