ICU或脓毒血症液体复苏__培训课件.ppt

HES 130/0.4 vs saline (CHEST study): safety and efficacy in the ICU? AKI, acute kidney injury; CHEST, Crystalloid versus Hydroxyethyl Starch Trial; HES, hydroxyethyl starch; ICU, intensive care unit; RIFLE, risk, injury, failure, loss and end-stage kidney injury; RRT, renal replacement therapy Myburgh et al. N Engl J Med 2012; 367: 1901–1911 Aim Evaluate safety of HES 130/0.42* vs saline in ICU patients Study design Multicentre, parallel group, blinded, randomised Comparison 6% HES 130/0.4 (N=3315) 0.9% saline (N=3336) Maximum daily dose: 50 mL/kg body-weight/day However, the mean daily dose was 526 mL, substantially max Patients ≥18 years Required fluid resuscitation in the ICU Heterogenous; patients with sepsis at baseline:HES 130/0.4 (N=979), saline (N=958) Primary endpoint Death at 90 days post-randomisation Secondary endpoints Incidence of AKI (5-category RIFLE criteria) Use of RRT Duration of RRT and mechanical ventilation Specified new organ failures Cause-specific mortality Within 90 days post-randomisation Trend to higher mortality with HES 130/0.4 vs saline in the ICU1 CI, confidence interval; HES, hydroxyethyl starch; RR, relative risk 1. Myburgh et al. N Engl J Med 2012; 367: 1901–1911; 2. Perner et al. N Engl J Med 2012; 367: 124–134 RR 1.06 (95% CI 0.96, 1.18) p=0.26 Rate of death was lower than expected due to patient exclusions, and substantially lower than that observed in similar studies (e.g. 6S study)1,2 However, a non-statistically significant increase in mortality at day 90 was observed with HES 130/0.4 compared with saline1 HES 130/0.4 Saline HES 130/0.4 significantly increases risk of RRT vs saline in the ICU Within 90 days post-randomisation. CI, confidence interval; HES, hydroxyethyl starch; RR, relative risk; RRT, renal replacement therapy Myburgh et al. N Engl J Med 2012; 367: 1901–1911 RR 1.21 (95% CI 1.00, 1.45) 21% p=0.04 Saline HES 130/0.4 Creatinine levels* revealed significantly higher risk of injury and failure in the H