Landmark study on IV fluids

A landmark study by Australian and New Zealand researchers, CHEST (The Crystalloid vs Hydroxyethyl Starch Trial) has found that a widely used starch fluid for resuscitation of patients in intensive care units provides no clinical benefit and its use results in increased acute kidney failure (haemodialysis) when compared to normal saline.

Published in the New England Journal of Medicine, the study randomly assigned 7000 patients who had been admitted to an intensive care unit to either the starch fluid or the normal saline. The primary outcome was death within 90 days. Secondary outcomes included acute kidney injury and failure and treatment with renal-replacement therapy.  The results of the trial showed that, in patients in the ICU, there was no significant difference in 90-day mortality between patients resuscitated with 6% HES (130/0.4) or saline. However, more patients who received resuscitation with HES were treated with renal-replacement therapy.

Myburgh, J.A. et al “Hydroxyethyl Starch or Saline for Fluid Resuscitation in Intensive Care” NEJM October 17, 2012DOI: 10.1056/NEJMoa1209759