A new study reports that hydroxyethyl starch (HES) does not provide clinical benefit over saline for fluid resuscitation in the intensive care unit (ICU). Myburgh et al.'s study randomly assigned 7,000 patients admitted to an ICU to receive either 6% HES or saline for all fluid resuscitation until discharge, death or 90 days after randomization. Mortality at 90 days was similar in the two groups, and renal replacement therapy use was higher in the HES group. In addition, HES was associated with an increased incidence of adverse events, particularly pruritis and rash.