Fluid therapy change from synthetic colloids to only crystalloids in patients with severe sepsis

Introduction

After changing the standard resuscitation colloid on our ICU from 6% HES 130/0.4 to 4% gelatin, we found that both HES 130/0.4 and gelatin resulted in a high incidence of renal failure (43.2% and 40.2%) in patients with severe sepsis [1]. We therefore changed from synthetic colloids to only crystalloids and herewith report on the effects.

Methods

Before-after retrospective study in patients with severe sepsis on a surgical ICU. The synthetic colloids group (SynColl-Group) comprised patients who received either predominantly 6% HES 130 or predominantly gelatin between January 2005 and June 2006. The crystalloid group (Crys-Group) comprised patients from September 2008 to June 2009 who received only crystalloids. Acute renal failure (ARF) was defined as new need for renal replacement therapy (RRT) or at least a twofold increase in baseline creatinine.

Results

Two hundred and five patients received synthetic colloids, and 141 received only crystalloids. There were minor baseline differences but SAPS II and SOFA scores, age and creatinine were similar at admission. Fluid therapy (median cumulative doses): patients in the SynColl-Group received 4 l (IQR 2 to 8.3 l) colloids and 27.9 l (IQR 15.7 to 48.3 l) crystalloids. Patients in the Crys-Group received only 25.0 l (IQR 13.1 to 52.2 l) crystalloids. Crystalloid volumes did not differ significantly between groups (P = 0.605). Median cumulative dose of HES was 50 ml/kg and of gelatin was 43.3 ml/kg. Outcomes: patients in the SynColl-group had a higher incidence of ARF (41.0% vs 23.4%, P = 0.001) and increased need for RRT (35.1% vs 22.0%, P = 0.009). ICU mortality and hospital mortality did not differ between SynColl and Crys groups (31.2% vs 30.5% and 38% vs 36.9%, respectively). The ICU length of stay tended to be longer in the SynColl-Group (14 versus 10 days, P = 0.055).

Conclusions

In patients with severe sepsis, fluid therapy with synthetic colloids - gelatin or the third-generation 6% HES 130/0.4-considerably increases the incidence of ARF and need for RRT compared with crystalloids. These results confirm recent meta-analysis and RCTs, which demonstrated an increased incidence of ARF by synthetic colloids [2, 3].