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Fluid Management and Risk Factors for Renal Dysfunction in Patients with Severe Sepsis and/or Septic Shock
Study Question: Is the use of low molecular weight hydroxyethylstarch (HES 130/0.4) in sepsis or septic shock associated with the development of renal dysfunction?
Study Description: This article describes a retrospective review of a French, multicenter study pre- and post-implementation of ten recommendations from the Surviving Sepsis Campaign guidelines. The purpose was to determine factors associated with renal dysfunction. Prescribers were able to choose fluids, antibiotics, and vasoactive medication at their discretion.
Results: During the first 24 hours of severe sepsis or septic shock, 379/388 (98%) of patients received either HES 130/0.4 (10%), crystalloids (17%), or both (73%). The mean total amount of fluid during the first 24 hours was 3,780 ± 2,487 mL. The mean volume of HES 130/0.4 in 0-6 hours was 938 ± 529 mL and 830 ± 731 mL in 6-24 hours. On regression analysis, the following patient characteristics were independently associated with renal dysfunction: male gender, increase in Simplified Acute Physiology II (SAPS II) score, surgical admission, no Sequential Organ Failure Assessment (SOFA) score improvement during first 24 hours. The need for vasopressors and baseline creatinine were independently associated with renal replacement therapy.
Conclusion(s): HES 130/0.4 was widely used and not associated with renal dysfunction.
Perspective: At best, this observational study provides hypothesis-generating information. However, due to multiple limitations (e.g., prescriber able to choose therapies, how quickly fluid given, variability in compliance with recommendations), it does not provide strongly applicable clinical guidance.