Shocking News for the NHS

Researchers at the London School of Hygiene and Tropical Medicine have slammed the use of starch-based intravenous fluids in critically ill patients. The group analysed data from 25 randomised controlled trials – the gold standard for evaluating the effectiveness of a medical intervention – to conclude that the preferential use of these fluids over a cheaper and safer alternative could lead to 250 unnecessary patient deaths in the UK each year.

For decades, starch-based intravenous fluids (colloids) and saline based fluids (crystalloids) have been used to stabilise patients with circulatory shock – a dangerously low blood pressure that impedes the transport of oxygen and nutrients to the body’s tissues. Colloids and crystalloids increase blood volume and thus the delivery of these key substances to vital organs such as the brain, heart, liver and kidneys. A fierce debate has long raged regarding the efficacy of colloid and crystalloid fluids in patients who have suffered severe burns, nasty infections and profuse bleeding – three important causes of shock.

The study involved more than 9000 critically ill patients who received either colloid or crystalloid fluids following trauma, surgery, burns or severe infections. Strikingly, patients prescribed colloids were 10% more likely to die.  The findings have led Dr Ian Roberts, the director of the School’s clinical trials unit and lead author of the study, to call on the NHS to prohibit the use of colloids in the management of circulatory shock.

With the European Medicines Agency conducting a review of starch-based intravenous fluids in the management of critically ill patients, it appears that the stage is set for the retraction of colloid therapy. The adoption of a cheaper and safer alternative will doubtlessly benefit a cash-strapped NHS and its seriously ill patients.