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Related Experiment Video

Updated: Dec 19, 2025

Description of a Swine Infant Model of Volume-Controlled Hemorrhagic Shock
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New insights into fluid resuscitation.

John Myburgh1, Lauralyn McIntyre

  • 1Critical Care Medicine, The George Institute for Global Health, St George Clinical School, University of New South Wales, Sydney, Australia. j.myburgh@unsw.edu.au

Intensive Care Medicine
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Hydroxyethyl starch (HES) solutions increase mortality and the need for renal replacement therapy (RRT) in critically ill patients. These findings question the use of HES for fluid resuscitation due to potential toxicity.

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Area of Science:

  • Critical Care Medicine
  • Nephrology
  • Pharmacology

Background:

  • Recent randomized controlled trials (RCTs) have investigated fluid resuscitation in critically ill patients.
  • Hydroxyethyl starch (HES) preparations and crystalloids are commonly used for fluid resuscitation.

Purpose of the Study:

  • To evaluate the comparative effects of HES preparations and crystalloids for fluid resuscitation in critically ill patients.
  • To synthesize evidence from recent systematic reviews on HES use.

Main Methods:

  • Analysis of high-quality randomized-controlled trials.
  • Inclusion of data from systematic reviews incorporating new trial results.
  • Assessment of outcomes including mortality and renal replacement therapy (RRT).

Main Results:

  • HES use is associated with an increased risk of death.
  • HES use is linked to a higher incidence of renal replacement therapy (RRT).
  • These risks are observed regardless of HES type or dose in intensive care and sepsis patients.

Conclusions:

  • HES solutions demonstrate potential toxicity, leading to increased mortality and RRT use.
  • The clinical role of semi-synthetic colloids like HES for fluid resuscitation requires re-evaluation.
  • Careful consideration of HES administration in critically ill patients is mandated.