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Hydroxyethyl Starch or Saline for Fluid Resuscitation in Intensive Care

Myburgh, John A., Finfer, Simn, Bellomo, Rinaldo, Billot, Lauent, Cass, Alan, Gattas, David, Glass, Parsa, Lipman, Jeffrey, Liu, Bette, McArthur, Colin, McGuinness, Shay, Rajbhandari, Dorrilyn, Taylor, Coman B., Webb, Steven A. R. and Australian and New Zealand Intensive Care Society Clinical Trials Group (2012). Hydroxyethyl Starch or Saline for Fluid Resuscitation in Intensive Care. New England Journal of Medicine,367(20):1901-1911.

Document type: Journal Article

IRMA ID 84473293xPUB56
Title Hydroxyethyl Starch or Saline for Fluid Resuscitation in Intensive Care
Author Myburgh, John A.
Finfer, Simn
Bellomo, Rinaldo
Billot, Lauent
Cass, Alan
Gattas, David
Glass, Parsa
Lipman, Jeffrey
Liu, Bette
McArthur, Colin
McGuinness, Shay
Rajbhandari, Dorrilyn
Taylor, Coman B.
Webb, Steven A. R.
Australian and New Zealand Intensive Care Society Clinical Trials Group
Journal Name New England Journal of Medicine
Publication Date 2012
Volume Number 367
Issue Number 20
ISSN 0028-4793   (check CDU catalogue open catalogue search in new window)
Scopus ID 2-s2.0-84868684501
Start Page 1901
End Page 1911
Total Pages 10
Place of Publication United States
Publisher Massachusetts Medical Society
HERDC Category C1 - Journal Article (DIISR)
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.

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.


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 (4.6% vs. 3.3%, P=0.006).

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 number, NCT00935168.)
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