title: New insights into fluid resuscitation.
abstract: Recent high-quality randomised-controlled trials comparing the effects of hydroxyethyl starch (HES) preparations and crystalloids for fluid resuscitation in critically ill patients have demonstrated an increased risk of death and use of renal replacement therapy (RRT). Consequently, a number of systematic reviews incorporating these new results have been published that have consistently demonstrated an increased risk of death and use of RRT associated with HES solutions, regardless of type of HES and dose administered, both in general intensive care patients and in those with severe sepsis. These effects become apparent in the post-resuscitation period and may relate to increased tissue accumulation associated with HES. These results question the clinical role of semi-synthetic colloids for fluid resuscitation and mandate a reappraisal about how these fluids are administered to critically ill patients, specifically considering the potential for toxicity.
authors.affiliation: Critical Care Medicine, The George Institute for Global Health, St George Clinical School, University of New South Wales, Sydney, Australia. j.myburgh@unsw.edu.au
authors.forename: John
authors.initials: J
authors.lastname: Myburgh
authors.forename: Lauralyn
authors.initials: L
authors.lastname: McIntyre
mesh_terms: D003422:Critical Care / Q000379:methods*; D000077324:Crystalloid Solutions; D019317:Evidence-Based Medicine; D005440:Fluid Therapy / Q000639:trends*; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000009:adverse effects / Q000627:therapeutic use*; D007552:Isotonic Solutions / Q000009:adverse effects / Q000627:therapeutic use; D010952:Plasma Substitutes / Q000009:adverse effects / Q000627:therapeutic use*; D015532:Rehydration Solutions / Q000009:adverse effects / Q000627:therapeutic use; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data; D018805:Sepsis / Q000628:therapy
chemical_list: D000077324:Crystalloid Solutions; D006895:Hydroxyethyl Starch Derivatives; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D015532:Rehydration Solutions
references.citation: N Engl J Med. 2004 May 27;350(22):2247-56
references.pmid: 15163774
references.citation: N Engl J Med. 2011 Jun 30;364(26):2483-95
references.pmid: 21615299
references.citation: Intensive Care Med. 2011 Jan;37(1):86-96
references.pmid: 20924555
references.citation: Crit Care Med. 2011 Feb;39(2):259-65
references.pmid: 20975548
references.citation: BMJ. 2013 Feb 15;346:f839
references.pmid: 23418281
references.citation: Crit Care Med. 2011 Jun;39(6):1335-42
references.pmid: 21358396
references.citation: Intensive Care Med. 2013 Apr;39(4):558-68
references.pmid: 23407978
references.citation: Intensive Care Med. 2013 May;39(5):811-22
references.pmid: 23430019
references.citation: Crit Care. 2012 May 24;16(3):R94
references.pmid: 22624531
references.citation: N Engl J Med. 2012 Jul 12;367(2):124-34
references.pmid: 22738085
references.citation: N Engl J Med. 2007 Aug 30;357(9):874-84
references.pmid: 17761591
references.citation: N Engl J Med. 2012 Nov 15;367(20):1901-11
references.pmid: 23075127
references.citation: Crit Care. 2010;14(5):R185
references.pmid: 20950434
references.citation: Ann Surg. 2012 May;255(5):821-9
references.pmid: 22470070
references.citation: JAMA. 2013 Feb 20;309(7):678-88
references.pmid: 23423413