- Paper Report
- Open Access
'No' to starch in sepsis
- Jonathon Ball1
© Biomed Central Ltd 2001
- Received: 30 April 2001
- Published: 4 December 2001
- Acute renal failure
- colloid fluid resuscitation
There has been, and indeed remains, much debate as to the optimal fluid management of critically ill patients, especially those with sepsis, both in terms of the dose and the composition of the fluids employed. What little evidence exists is mostly contradictory. There is good evidence that packed red blood cells are detrimental (see Additional information [1,2]), although the mechanism is disputed. Aside from this, the colloid versus crystalloid debate continues. This is complicated by the variety of colloids available with comparisons between gelatins, starches, and albumin impossible to make. This study aimed to and succeeded in answering the question, "Does hydroxyethylstarch cause renal failure in septic patients?" The main impetus for this trial was a study from braindead organ donors where a higher incidence of renal failure was noted in recipients of organs from subjects who had received hydroxyethylstarch (see Additional information ).
Acute renal failure (ARF) defined as the need for renal replacement therapy or a twofold increase in serum creatinine concentration over the value at study entry, was more common in the hydroxyethylstarch group (odds ratio 2.32). Multivariate analysis also found mechanical ventilation and absence of fluid loading prior to study entry to be independent risk factors for ARF. Despite this, the length of intensive care unit (ICU) stay and ICU mortality were the same in both groups. The authors concluded that since the groups were well matched, the differences observed were due to the hydroxyethylstarch. They suggested that this particular starch be avoided in patients at risk of renal failure, and that other starches should be used with caution.
Multicentre randomized single blind study.
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Hebert PC, Yetisir E, Martin C, Blajchman MA, Wells G, Marshall J, Tweeddale M, Pagliarello G, Schweitzer I: Is a low transfusion threshold safe in critically ill patients with cardiovascular diseases? Crit Care Med 2001, 29:227-234.
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