UMEM Educational Pearls

Category: Critical Care

Title: Sugar isn't always so sweet

Posted: 10/22/2012 by Haney Mallemat, MD (Emailed: 10/24/2012) (Updated: 10/24/2012)
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A study by Perner, et al recently published in NEJM observed that using hydroxyethyl starch (HES) as a resuscitation fluid increased mortality and renal replacement therapy at 90 days as compared to lactated acetate.
Another recent trial, called the “Crystalloid versus Hydroxyethyl Starch Trial” (CHEST) was a prospective randomized control trial from Australia comparing the use of 6% HES and 0.9% sodium chloride as a resuscitation fluid in the critically ill. 
With 7,000 patients enrolled (3,500 in each group), the CHEST trial is the largest single-trial of HES to date; the primary outcome was 90-day mortality and secondary outcomes were acute kidney injury (AKI) and renal-replacement therapy
The study concluded that there was no difference between groups for either morality or renal failure, but significantly more patients in the HES group required renal replacement therapy.
Bottom line: There is still no convincing data that patients receiving HES as part of their resuscitation have better outcomes compared to crystalloid (normal saline or lactated ringers) and there is increased harm with their use. Furthermore, the increased cost of HES does not appear to justify their routine use.


Perner A., et al. Hydroxyethyl Starch 130/0.4 versus Ringer's Acetate in Severe Sepsis. NEJM. 2012 Jun 27.

MyBurgh, J. Hydroxyethyl Starch or Saline for Fluid Resuscitation in Intensive Care. N Engl J Med. 2012 Oct 17.
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