Hydroxyethyl Starch or Saline for Fluid Resuscitation?

Most internists use crystalloid as a first choice fluid for resuscitation. Newer colloids, however, might allow for more effective resuscitation with smaller volumes, while avoiding kidney injury associated with first-generation synthetic colloids and cost of albumin.

In this multicenter trial from Australia and New Zealand, 7000 intensive care unit (ICU) patients who required fluid resuscitation were randomized to receive either normal saline or 6% hydroxyethyl starch (HES) 130/0.4 (a synthetic colloid with lower molecular weight and lower substitution ratio than traditional colloids). Need for resuscitation was determined by treating clinicians, resulting in a cohort with a wide variety of clinical indications for resuscitation. Patients w…