Fluid therapy in severe sepsis: results from a representative survey of German ICUs

Introduction

Fluid resuscitation is a mainstay of sepsis management.

Objective

To describe the practice of fluid therapy in German ICUs.

Method

Analysis of data derived from the SepNet cross-sectional 1-day point-prevalence study of patients with sepsis [1]. ICU directors were asked about their fluid preferences. Data on days after start of sepsis were adjusted to account for overestimation of long-stayers in a point-prevalence survey. SPSS 15.0.1 (SPSS, Chicago, IL, USA) was used; the chi-square test or Kruskal-Wallis H test was applied where appropriate.

Results

On operative ICUs, more patients received synthetic colloids (41.4 vs. 21.2%, P < 0.001) and crystalloids (74.6 vs. 65.0%, P < 0.05), while albumin use did not differ. ICU directors of operative ICUs stated using synthetic colloids more frequently and albumins less frequently than their colleagues from nonoperative ICUs. Stated and actual fluid use did not differ by hospital size. Of 415 patients with severe sepsis, 71.6% received crystalloids. 35.2% synthetic colloids (HES; gelatin, dextran), 16.4% received 5% glucose, and 4.1% albumin solutions. HES was the most frequently used colloid. It was administered to 29.4% of patients as HES 10% in 10.4% (mean dose, 787.8 ± 420.0 ml/24 hours) and as HES 6% in 20.7% (mean dose, 769.1 ± 403.1 ml/24 hours). Patients receiving HES had a higher mean SOFA score than patients without HES (9.92 ± 4.12 vs. 8.00 ± 4.07, P < 0.001), tended to more frequent acute renal failure (ARF) (defined as serum creatinine >1.5 mg/dl (132.6 μmol/l) and diuresis ≤500 ml/day, no chronic replacement therapy, RRT), more RRT, lower thrombocyte counts and more frequently received RBCs, but this was non-significant. In total, 29.5% of patients with ARF and 30.3% of patients with RRT received HES. HES was administered to 115 patients between day 0 and day 63 after the start of severe sepsis.

Conclusion

Fluid therapy in septic patients varied by type of ICU. About 30% of patients received HES regardless of renal dysfunction. HES was applied for many days after the start of severe sepsis.