No Increase in ICU Death With HES for Fluid Resuscitation
But use of 6 percent hydroxyethyl starch correlates with increase in renal-replacement therapy
WEDNESDAY, Oct. 17 (HealthDay News) -- Use of hydroxyethyl starch (HES) for fluid resuscitation in the intensive care unit (ICU) is not associated with increased 90-day mortality but does correlate with increased use of renal-replacement therapy, according to a study published online Oct. 17 in the New England Journal of Medicine to coincide with presentation at the annual meeting of the European Society of Intensive Care Medicine, held from Oct. 13 to 17 in Lisbon, Portugal.
John A. Myburgh, M.D., Ph.D., from the George Institute for Global Health in Sydney, Australia, and colleagues examined the safety and efficacy of HES for fluid resuscitation in the ICU. Seven thousand patients who had been admitted to the ICU were randomized to receive either 6 percent HES in 0.9 percent sodium chloride or saline for all fluid resuscitation until ICU discharge, death, or 90 days after randomization.
The researchers found that 18 percent of the HES group and 17 percent of the saline group died (relative risk in the HES group, 1.06; P = 0.26). For six predefined subgroups, there were no significant differences in mortality. Renal-replacement therapy was used in 7.0 and 5.8 percent of the HES and saline groups, respectively (relative risk, 1.21; P = 0.04). Renal injury occurred in 34.6 and 38.0 percent (P = 0.005) and renal failure occurred in 10.4 and 9.2 percent (P = 0.12) of the HES and saline groups, respectively. There were significantly more adverse events in the HES group.
"In patients in the ICU, there was no significant difference in 90-day mortality between patients resuscitated with 6 percent HES (130/0.4) or saline," the authors write. "However, more patients who received resuscitation with HES were treated with renal-replacement therapy."