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Study suggests no increased ICU mortality risk from starch drips

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There is no significant difference in critical care mortality between patients given crystalloids fluid replacement therapies and those receiving colloid solutions, according to French researchers.  

Intensive care fluid therapy includes a broad variety of products that are categorised as crystalloids and colloids – crystalloids are salts, while colloids are salts and gelatin, starch or protein.

Compared with crystalloids, colloid solutions expand blood volume and last longer. However, colloids may increase illness and death in critically ill patients, leading to a debate over what is the best fluid therapy in the ICU population.

Current international guidelines from the Surviving Sepsis Campaign recommended crystalloids as the preferred fluid therapy and against the use of hydroxyethyl starches, and European regulators have called for a ban on them.

French researchers from Raymond Poincare Hospital in Garches compared the effects of the two types of intravenous fluids on survival in 2,857 ICU patients.

The patients, at 57 units, required fluid resuscitation for sepsis or trauma, or hypovolemic shock without sepsis or trauma. They received either crystalloids or colloids for all fluid intervention except fluid maintenance throughout their ICU stay.

The researchers said there was no significant difference in mortality rates between groups over 28 days. There were 359 deaths (25.4%) among patients treated with colloids and 390 deaths (27%) among patients treated with crystalloids.

They added that “unexpectedly” there were fewer deaths at 90 days among those given colloids, but warned this set of results should be considered “exploratory” and needed replication in other trials.

At 90 days, there were 434 deaths (30.7%) among patients treated with colloids versus 493 deaths (34.2%) among patients treated with crystalloids.

Writing in the Journal of the American Medical Association, the study authors said: “Resuscitation with colloids was associated with more rapid weaning from life-support treatments.

“There was no evidence for a colloids-related increase in the risk for renal replacement therapy,” they added. “These findings are in contrast to previous reports showing increased incidence of acute kidney injury following administration of hydroxyethyl starches.”

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