CHEST Guidelines-Cost-effectiveness-of-Fluid-Resuscitation-of-Criti

Cost-effectiveness-of-Fluid-Resuscitation-of-Criti

Pdf Summary

The editorial by Craig M. Lilly, MD, and Sunkaru Touray, MBChB, MSc, discusses the cost-effectiveness of fluid resuscitation for critically ill adults, reflecting on findings from a study published in The Lancet Respiratory Medicine. The use of fluid resuscitation has been a pivotal aspect of critical care, involving choices between different fluids such as hydroxyethyl starch (HES) and saline. However, the impact of these choices on both the duration of illness and healthcare costs has been underexplored. <br /><br />The CHEST trial, a key study referenced in the editorial, compared the effectiveness and economic implications of a 6% HES resuscitation protocol with saline in critically ill patients. The cost-effectiveness analysis revealed minimal benefit in using HES over saline, with only an 11% probability of cost-effectiveness under a willingness-to-pay threshold of 50,000 per quality-adjusted life-year (QALY) at six months, slightly increasing at 24 months. Notably, the trial did not find differences in 90-day mortality and noted an increased need for renal replacement therapy with HES use, ultimately suggesting no preference for HES over saline for fluid resuscitation due to lack of economic and clinical benefits.<br /><br />The editorial underscores the necessity of high-quality cost-effectiveness studies to better understand critical care interventions. Given the significant financial burden of critical care, which comprises over 4% of US healthcare costs, understanding the costs relative to benefits of different treatment strategies is crucial. Thus, the study by Taylor et al. provides valuable insights and sets a framework for future evaluations of resuscitation management in critically ill patients. These findings are broadly applicable across different healthcare systems and highlight the importance of cost-effectiveness in clinical decision-making.

Keywords

cost-effectiveness

fluid resuscitation

critical care

hydroxyethyl starch

saline

CHEST trial

renal replacement therapy

quality-adjusted life-year

healthcare costs

clinical decision-making