Journal Club - Recent Additions

June - 2012


Showing Journal 1 of 9

Hydroxyethyl Starch 130/0.4 versus Ringers Acetate in Severe Sepsis

6S Trial Group and the Scandinavian Critical Care Trials Group New Eng J Med, 2012, DOI: 10.1056/NEJMoa1204242


This prospective multi-center parallel RCT trial of HES 130/0.4 vs Ringers in critically ill patients with severe sepsis reports an increase in 90-day mortality (51 vs 43%, RR 1.17 95% CI 1.01 to 1.36), requirement for renal replacement therapy (16 vs 10%, RR 1.35, 95% CI 1.01 to 1.80) and severe...


Previous Comments

Both CHEST and 6S were performed in patients requiring resuscitation fluids (largely at the discretion of the ICU team) while in the ICU. These are important trials that suggest HES should not be used in this context, given the apparent dose-dependent toxicity of HES to kidneys, and on mortality. However, there isn't evidence to support or refute the use of HES in other contexts such as resuscitation in the emergency department in trauma or severe sepsis, for instance. So we need to be careful not to over-extrapolate these trials. That notwithstanding, as John Myburgh says, HES should no longer be used outside the context of a clinical trial until there is evidence to support its use.
Ian-10 Jan, 2014 02:08:44 PM