Hydroxyethyl starch or saline for fluid resuscitation in intensive care.

@article{Myburgh2012HydroxyethylSO,
  title={Hydroxyethyl starch or saline for fluid resuscitation in intensive care.},
  author={John Myburgh and Simon R. Finfer and Rinaldo Bellomo and Laurent Billot and Alan Cass and David J Gattas and Parisa Glass and Jeffrey Lipman and Bette Liu and Colin McArthur and Shay P. McGuinness and Dorrilyn Rajbhandari and Colman B. Taylor and Steven A. R. Webb},
  journal={The New England journal of medicine},
  year={2012},
  volume={367 20},
  pages={
          1901-11
        }
}
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. 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… 

Figures and Tables from this paper

Hydroxyethyl starch for fluid resuscitation in critically ill patients
TLDR
The primary efficacy outcome was death within 90 days after randomization and the key secondary outcomes were incidence of acute kidney injury and development of new organ dysfunction, defined by the sequential organ failure assessment score.
Hydroxyethyl starch in sepsis.
  • N. Haase
  • Medicine
    Danish medical journal
  • 2014
TLDR
A randomised clinical trial is one of several high-quality trials in critically ill patients with and without sepsis that now provide evidence that the use of tetrastarch impairs kidney function and haemostasis and may even increase mortality.
Early fluid resuscitation with hydroxyethyl starch 130/0.4 (6%) in severe burn injury: a randomized, controlled, double-blind clinical trial
TLDR
There was no evidence that early fluid resuscitation with balanced HES 130/0.4 (6%) in addition to lactated Ringer’s solution would lead to a volume-sparing effect in severe burn injury and the findings that early renal function, incidence of ARDS, length of stay, and mortality were not negatively influenced by HES.
Fluid replacement with hydroxyethyl starch in critical care--a reassessment.
TLDR
Because of safety concerns, fluid replacement with HES in critically ill patients cannot be recommended and evidence for its superior efficacy, safety, safety and cost effectiveness in preoperative use is also lacking.
Comparison of the Effectiveness of Hydroxyethyl Starch (Voluven) Solution With Normal Saline in Hemorrhagic Shock Treatment in Trauma
TLDR
By using hydroxyethyl starch (Voluven) for fluid therapy in hemorrhagic shock caused by trauma, serum base excess decreases and results in improvement in tissue perfusion and better balance in acid-base status and it seems to be superior over normal saline administration.
Fluid resuscitation with 6 % hydroxyethyl starch (130/0.4 and 130/0.42) in acutely ill patients: systematic review of effects on mortality and treatment with renal replacement therapy
TLDR
The quality and quantity of data evaluating 6 % hydroxyethyl starch as a resuscitation fluid has increased in the last 12 months and patients randomly assigned to resuscitation with 6-% HES 130 are at significantly increased risk of being treated with RRT.
Effects of Fluid Treatment With Hydroxyethyl Starch on Renal Function in Patients With Aneurysmal Subarachnoid Hemorrhage
TLDR
The results suggest that the administration of HES 6% 130/0.4 is safe in SAH patients without preexisting renal insufficiency, and the first days after SAH seem to be a vulnerable phase in which a variety of interventions are performed, including contrast-enhanced neuroradiologic procedures.
Hydroxyethyl starch - friend or foe?
TLDR
A narrative review of recent literature was undertaken to establish the current utility and efficacy of HES in clinical practice and aims at increasing awareness amongst anesthetists and critical care specialist about correct and careful fluid administration.
Comparison of hydroxyethyl starch colloids with crystalloids for surgical patients: A systematic review and meta-analysis
TLDR
This meta-analysis, based on small studies with low event rates, suggests that there is currently insufficient data to identify a difference in outcomes associated with crystalloids and HES in scheduled or elective noncardiac surgery.
...
...

References

SHOWING 1-10 OF 28 REFERENCES
Hydroxyethyl starch 130/0.42 versus Ringer's acetate in severe sepsis.
TLDR
Patients with severe sepsis assigned to fluid resuscitation with HES 130/0.42 had an increased risk of death at day 90 and were more likely to require renal-replacement therapy, as compared with those receiving Ringer's acetate.
The Crystalloid versus Hydroxyethyl Starch Trial: protocol for a multi-centre randomised controlled trial of fluid resuscitation with 6% hydroxyethyl starch (130/0.4) compared to 0.9% sodium chloride (saline) in intensive care patients on mortality
TLDR
A large-scale multi-centre randomised controlled trial in critically ill patients is currently underway comparing fluid resuscitation with 6% HES 130/0.4 to 0.9% sodium chloride on 90-day mortality and other clinically relevant outcomes including renal injury.
A comparison of albumin and saline for fluid resuscitation in the intensive care unit.
TLDR
In patients in the ICU, use of either 4 percent albumin or normal saline for fluid resuscitation results in similar outcomes at 28 days, with no significant differences between the groups.
Resuscitation with hydroxyethyl starch improves renal function and lactate clearance in penetrating trauma in a randomized controlled study: the FIRST trial (Fluids in Resuscitation of Severe Trauma).
TLDR
In penetrating trauma, HES provided significantly better lactate clearance and less renal injury than saline, and no firm conclusions could be drawn for blunt trauma.
Intensive insulin therapy and pentastarch resuscitation in severe sepsis.
TLDR
The use of intensive insulin therapy placed critically ill patients with sepsis at increased risk for serious adverse events related to hypoglycemia and HES was harmful, and its toxicity increased with accumulating doses.
Assessment of hemodynamic efficacy and safety of 6% hydroxyethylstarch 130/0.4 vs. 0.9% NaCl fluid replacement in patients with severe sepsis: The CRYSTMAS study
TLDR
There was no difference between AKIN and RIFLE criteria among groups and no difference in mortality, coagulation, or pruritus up to 90 days after treatment initiation, and significantly less volume was required to achieve HDS for HES vs. NaCl in the initial phase of fluid resuscitation in severe sepsis patients.
Fluid resuscitation with 6% hydroxyethyl starch (130/0.4) in acutely ill patients: an updated systematic review and meta-analysis.
TLDR
A systematic review and meta-analysis of unretracted randomized controlled trials comparing the effects of 6% HES 130/0.4 with other colloid or crystalloid solutions on mortality, acute kidney injury/failure, and bleeding in acutely ill or perioperative patients concluded that high-quality trials reporting a large number of events are urgently required.
[Hydroxyethyl starch to protect renal function in laparoscopic surgery].
TLDR
Prehydration with Voluven can be an effective measure for protecting renal function against the adverse effects of pneumoperitoneum in laparoscopic surgery.
Resuscitation fluid use in critically ill adults: an international cross-sectional study in 391 intensive care units
TLDR
Although colloid solutions are more expensive and may possibly be harmful in some patients, they were administered to more patients and during more resuscitation episodes than crystalloids were and choice of fluid varies markedly between countries.
...
...