October - 2012
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 Hydroxyethyl Starch or Saline for Fluid Resuscitation in Intensive CareJohn A. Myburgh, Simon Finfer, Rinaldo Bellomo, et al for the CHEST Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group NEJM, 2012, 367:1901-191 This page is only available to Crit-IQ subscribers. To view the rest of this review and gain access to our vast array of critical care teaching tools including podcasts, vodcasts, modules, exam preparation tools, teaching aids and much more, login here, or Become a Member to register |
October |
Previous Comments
| I have heard it said that the published difference between renal injury is exclusive of confounding factors and when they are adjusted for the difference is non-significant. Is anyone able to comment on this? | |
| Andrew Stapleton-23 Nov, 2012 07:32:54 AM | |
| I would have read this study if it was going to make a difference to my practice. WE NEVER USE hydroxyethylstarch in the ICUs that we work. Never have and Never will. It has long been known (especially for those who have worked in the UK and have used HESPAN)that this "artificial stuff" had many unnecessary risks unless used sensibly ie limit use to 500mmls or 1000mls and use another substitute if more colloid was used. The ill effects were coagulopathies (mostly dilution), effects on the RES, Hyperchloremia and acidosis (as with most saline containing fluids), Renal impairment. HESPAN of course was a larger molecular weight substance but still, it was starch being used as a colloid. I am very surprised that Starch is being used in ICUs in Australia as a colloid. The side effects and the profile of HES was known 20yrs ago in the UK. While the methodology of the study and the effort thats gone into this study needs to be commended, surely one cannot help thinking that all this study does is making explicit what was already known. | |
| whats the point?-25 Nov, 2012 09:44:16 AM | |
| Fair enough I guess. I suppose though that there is enough starch usage worldwide that there is sufficient equipoise to justify the study. Strangely though, this was conducted in a region where it is used infrequently (so you'd think there was little equipoise). Therese Jaques from St George in Sydney raised an interesting thought though at the recent annual scientific meeting - are there starches and starches? Are they all the same? Is it possible that we'll still see new starches introduced that have a kinder side effect profile? | |
| Todd Fraser-27 Nov, 2012 02:04:37 PM | |
| interesting development in QLD.... voluven has been taken off the standard drugs list. I just wonder is this throwing out the baby with the bath water? So for colloids we are effectively left only with blood products which carry their own issues....hence the recent drive for lower transfusion thresholds etc. All the fluids we use have problems, I just think its all about choosing the right fluid for the right patient in the right time, rather than deciding that nobody can ever use a certain fluid. | |
| helen-09 Dec, 2012 06:18:04 PM | |
Comment
This is a landmark paper in the critical care literature, and a major achievement by the ANZICS CTG. It adds to the major contribution they have made in the area of fluid in critical care with the SAFE trial. This trial was performed in Australia and New Zealand, where Voluven was being...