Hydroxyethyl starch or saline for fluid resuscitation in intensive care

John A Myburgh, Simon R Finfer, Rinaldo Bellomo, Laurent Billot, Alan Cass, David J Gattas, Parisa Glass, Jeff Lipman, Bette Liu, Colin McArthur, Shay P McGuinness, Dorrilyn Rajbhandari, Colman B Taylor, Steven A R Webb

Research output: Contribution to journalArticleResearchpeer-review

Abstract

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
Original languageEnglish
Pages (from-to)1901 - 1911
Number of pages11
JournalNew England Journal of Medicine
Volume367
Issue number20
DOIs
Publication statusPublished - 2012
Externally publishedYes

Cite this

Myburgh, John A ; Finfer, Simon R ; Bellomo, Rinaldo ; Billot, Laurent ; Cass, Alan ; Gattas, David J ; Glass, Parisa ; Lipman, Jeff ; Liu, Bette ; McArthur, Colin ; McGuinness, Shay P ; Rajbhandari, Dorrilyn ; Taylor, Colman B ; Webb, Steven A R. / Hydroxyethyl starch or saline for fluid resuscitation in intensive care. In: New England Journal of Medicine. 2012 ; Vol. 367, No. 20. pp. 1901 - 1911.
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title = "Hydroxyethyl starch or saline for fluid resuscitation in intensive care",
abstract = "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",
author = "Myburgh, {John A} and Finfer, {Simon R} and Rinaldo Bellomo and Laurent Billot and Alan Cass and Gattas, {David J} and Parisa Glass and Jeff Lipman and Bette Liu and Colin McArthur and McGuinness, {Shay P} and Dorrilyn Rajbhandari and Taylor, {Colman B} and Webb, {Steven A R}",
year = "2012",
doi = "10.1056/NEJMoa1209759",
language = "English",
volume = "367",
pages = "1901 -- 1911",
journal = "New England Journal of Medicine",
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Myburgh, JA, Finfer, SR, Bellomo, R, Billot, L, Cass, A, Gattas, DJ, Glass, P, Lipman, J, Liu, B, McArthur, C, McGuinness, SP, Rajbhandari, D, Taylor, CB & Webb, SAR 2012, 'Hydroxyethyl starch or saline for fluid resuscitation in intensive care' New England Journal of Medicine, vol. 367, no. 20, pp. 1901 - 1911. https://doi.org/10.1056/NEJMoa1209759

Hydroxyethyl starch or saline for fluid resuscitation in intensive care. / Myburgh, John A; Finfer, Simon R; Bellomo, Rinaldo; Billot, Laurent; Cass, Alan; Gattas, David J; Glass, Parisa; Lipman, Jeff; Liu, Bette; McArthur, Colin; McGuinness, Shay P; Rajbhandari, Dorrilyn; Taylor, Colman B; Webb, Steven A R.

In: New England Journal of Medicine, Vol. 367, No. 20, 2012, p. 1901 - 1911.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Hydroxyethyl starch or saline for fluid resuscitation in intensive care

AU - Myburgh, John A

AU - Finfer, Simon R

AU - Bellomo, Rinaldo

AU - Billot, Laurent

AU - Cass, Alan

AU - Gattas, David J

AU - Glass, Parisa

AU - Lipman, Jeff

AU - Liu, Bette

AU - McArthur, Colin

AU - McGuinness, Shay P

AU - Rajbhandari, Dorrilyn

AU - Taylor, Colman B

AU - Webb, Steven A R

PY - 2012

Y1 - 2012

N2 - 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

AB - 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

UR - http://www.nejm.org/doi/full/10.1056/NEJMoa1209759

U2 - 10.1056/NEJMoa1209759

DO - 10.1056/NEJMoa1209759

M3 - Article

VL - 367

SP - 1901

EP - 1911

JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

IS - 20

ER -