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



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


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


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


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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