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Fixed Volume or Fixed Pressure: A Murine Model of Hemorrhagic Shock
Published on: June 6, 2011
Hydroxyethyl starch for fluid resuscitation in critically ill patients
Sean M Bagshaw1, Lakhmir S Chawla
1Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 3C1.12 Walter C. Mackenzie Centre, 8440-122 ST NW, Edmonton, AB, T6G 2B7, Canada. bagshaw@ualberta.ca
Summary
Hydroxyethyl starch (HES) resuscitation in critically ill patients showed no significant difference in 90-day mortality compared to saline. However, HES use was linked to increased renal replacement therapy needs and adverse events.
Area of Science:
- Critical care medicine
- Pharmacology
- Nephrology
Background:
- Intravenous fluid therapy is a common ICU intervention, with crystalloids and colloids like hydroxyethyl starch (HES) being debated for resuscitation.
- Emerging data question the safety and efficacy of HES, necessitating rigorous evaluation in large pragmatic trials.
Purpose of the Study:
- To assess the efficacy and safety of HES for fluid resuscitation in critically ill patients.
- Focus on patient survival and kidney function outcomes.
Main Methods:
- Multicenter, blinded, randomized controlled parallel-group trial involving 7,000 adult ICU patients.
- Patients received either 6% HES (130/0.4) or 0.9% sodium chloride (saline) for fluid resuscitation.
- Primary outcome: 90-day mortality; secondary outcomes included acute kidney injury (AKI), renal replacement therapy (RRT), and organ dysfunction.
Main Results:
- No significant difference in 90-day mortality between HES and saline groups (18.0% vs 17.0%).
- HES group showed a higher incidence of RRT (7.0% vs 5.8%) and adverse events (5.3% vs 2.8%), primarily pruritus and rash.
- HES was associated with decreased cardiovascular organ failure but increased hepatic organ failure.
Conclusions:
- 6% HES (130/0.4) and saline demonstrate similar 90-day mortality rates in critically ill patients requiring fluid resuscitation.
- Increased rates of RRT and adverse events were observed with HES, warranting careful consideration in clinical practice.
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