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Clinical practice of fluid resuscitation in severe sepsis and septic shock on German ICUs

Objectives

Intravascular fluid resuscitation is one of the mainstays of supportive therapy in severe sepsis or septic shock. However, despite decades of research, there is still ongoing controversy whether crystalloid or colloid fluids should be used. Therefore the choice of fluids varies widely. In order to describe current clinical practice, we analyzed the epidemiological data derived from the Prevalence Study of Severe Sepsis and Septic Shock in Intensive Care Units in Germany.

Methods

The study was designed as a prospective observational cross-sectional study. A representative random sample of 454 ICUs out of a total 2075 ICUs was obtained. According to hospital size, five strata (<200, 201–400, 401–600, >600 beds and university hospitals) were established. All data were collected by specially trained physicians from SepNet who used ACCM/SSCP criteria. Visits were randomly distributed over a 1-year period to allow assessment of seasonal variations.

Results

Four hundred and fifteen patients with severe sepsis or septic shock were identified, representing a total of approximately 1500 patients with severe sepsis and/or septic shock. Crystalloids were administrated in 87% of the patients. In this subgroup 57% received full electrolyte solutions (median: 1500 ml; 25/75 percentile: 1000–2000 ml), whereas in 30% of patients NaCl 0.9% was used (1000 ml; 500–1575 ml). A combination of 0.9% NaCl with full electrolyte solutions was administered in 12.8% of patients. Other crystalloid solutions such as 1/2 or 2/3 electrolyte solution or glucose 5% did not play a role in fluid therapy. Artificial colloids such as gelatins or hydroxyethyl starch (HES 6% or 10%) were used much less frequently. Gelatins, HES (6%) or HES (10%) were administered as follows: gelatins, 10.2% (500 ml; 500–1000 ml); HES (6%), 23.5% (500 ml; 500–1000 ml); HES (10%), 12.1% (500 ml; 500–1000 ml). A combination of crystalloids and colloids was observed in 36.3% of the patients. Albumin (HA) was used in 0.5% (HA 5%) and 4.0% (HA 20%) of the patients, respectively. There was no significant difference in hospital-size strata.

Conclusion

There is a marked preference for crystalloid fluid resuscitation (87% of patients) in the treatment of severe sepsis in Germany, whereas colloids are used to a much lesser degree (46%), among them most frequently HES 6% (24%) and gelatins (10%). Human albumin does not play a role in volume replacement therapy. Fluid choice is not associated with hospital size. The relatively low amount of colloids administered may be explained by time delay between onset of sepsis and the visiting day (mean 7.7 days).

Acknowledgements

Supported by BMBF-Grant No. 01KI0106 and Lilly Deutschland GmbH.

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Ragaller, M., Engel, C., Gotschlich, B. et al. Clinical practice of fluid resuscitation in severe sepsis and septic shock on German ICUs. Crit Care 10, P184 (2006). https://doi.org/10.1186/cc4531

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Keywords

  • Septic Shock
  • Gelatin
  • Severe Sepsis
  • Hydroxyethyl
  • Fluid Resuscitation