Crystalloid vs. Hydroxy-Ethyl Starch Trials (CHEST)
Fluid resuscitation is a fundamental component of the haemodynamic management of critically ill patients and the choice of fluid is a longstanding issue of debate. Broadly, resuscitation fluids can be divided into colloids (eg. 6% hydroxyethyl starch (130/0.4)) and crystalloids (eg. Saline). Currently there is little high quality evidence available to clinicians in order to guide their clinical decision-making when choosing resuscitation fluids.
The CHEST study is a prospective, multi-centre, concealed, randomised controlled trial of 6% hydroxyethyl starch (130/0.4) in 0.9% sodium chloride for intravascular volume resuscitation in the Intensive Care Unit (ICU) compared to those 0.9% sodium chloride (saline) alone. The study is a collaboration of The George Institute For International Health, The ANZICS Clinical Trials Group and the University of Sydney.
To determine the effect of intravenous fluid resuscitation with 6% hydroxyethyl starch in 0.9% sodium chloride solution (Voluven®) compared to 0.9% sodium chloride alone (saline) on all-cause mortality in critically ill patients.
CHEST was conducted as a multi-centred, prospective, randomised controlled, double-blind study. 7000 patients were recruited in over 25 Intensive Care Units throughout Australia and New Zealand. Participants were randomised to receive either 6% hydroxyethyl starch (130/0.4) or saline for all resuscitation episodes whilst in the intensive care unit for up to 90 days.
Recruiting commenced December 2009 and was completed in January 2012. A total of 7000 patients were enrolled. The statistical analysis for the primary outcome (all cause mortality at Day 90 visit) was published in 2012. This study was completed in 2013.