Hydroxyethyl starch or saline for fluid resuscitation in intensive care

Myburgh, John A., Finfer, Simon, Bellomo, Rinaldo, Billot, Lauren, Cass, Alan, Gattas, David, Glass, Parisa, Lipman, Jeffrey, Liu, Bette, McArthur, Coline, McGuinness, Shay, Rajbhandari, Dorrilyn, Taylor, Colman B., Webb, Steven A. R., for the CHEST Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group and Reade, Michael (2012) Hydroxyethyl starch or saline for fluid resuscitation in intensive care. New England Journal of Medicine, 367 20: 1901-1911. doi:10.1056/NEJMoa1209759

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Author Myburgh, John A.
Finfer, Simon
Bellomo, Rinaldo
Billot, Lauren
Cass, Alan
Gattas, David
Glass, Parisa
Lipman, Jeffrey
Liu, Bette
McArthur, Coline
McGuinness, Shay
Rajbhandari, Dorrilyn
Taylor, Colman B.
Webb, Steven A. R.
for the CHEST Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group
Reade, Michael
Total Author Count Override 14
Title Hydroxyethyl starch or saline for fluid resuscitation in intensive care
Journal name New England Journal of Medicine   Check publisher's open access policy
ISSN 0028-4793
1533-4406
Publication date 2012-11-15
Sub-type Article (original research)
DOI 10.1056/NEJMoa1209759
Open Access Status File (Publisher version)
Volume 367
Issue 20
Start page 1901
End page 1911
Total pages 11
Place of publication Boston, MA, United States
Publisher Massachusetts Medical Society
Collection year 2013
Language eng
Formatted abstract
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.)
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2013 Collection
School of Medicine Publications
 
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Created: Wed, 19 Dec 2012, 23:19:12 EST by Michael Reade on behalf of School of Medicine