Salt is better than sugar

Myburgh JA, Finfer S, Bellomo R et al. Hydroxyethyl starch or saline for fluid resuscitation in intensive care. New England Journal of Medicine 2012; 367: 1901-1911.

RHH Journal Club. November 22nd, 2012. Dr Balaji Kasa

No free full-text available

To evaluate the safety and efficacy of 6% HES (130/0.4) in 0.9% saline as compared to 0.9% saline alone for fluid resuscitation in ICU.

Type of Study: Multicentre, Prospective, Blinded, Parallel group, Randomised controlled trial

Methodology:

Population:

7000 patients from 32 hospitals in Australia and New Zealand, 18 years or older eligible for admission to ICU and who met the criteria for fluid resuscitation

Exclusions: more than 1000mls of HES is administered to patient before screening, those with impending or current dialysis dependent renal failure and those with intracranial haemorrhage on CT scan.

Intervention /Control

HES(130/0.4) in 0.9% saline or 0.9% saline

Outcomes

Primary- all cause mortality for 90 days after randomisation

Secondary-incidence of acute kidney injury,  use of renal replacement therapy, new organ failures, duration of mechanical ventilation and renal replacement therapy and cause specific mortality

Results:

No difference in 90 day mortality.

Use of HES is associated with

– significant increased incidence of renal replacement therapy

– increased use of blood products& increased incidence of liver failure

– increased incidence of adverse events particularly rash and pruritis.

– decrease in the rate of new cardiovascular failure

Validity

Randomised – Yes, Allocation concealment- Yes, Blinded – Yes, Intention to treat- Yes, Experimental group comparable to control group- Yes

Can the results be applied to my patients- yes

 

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