الفهرس 
Sepsis reviewOnly 14 pages are availabe for public view
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Abstract
Sepsis is a syndrome characterized by inflammation-induced endothelial dysfunction leading to vascular leakage and vasodilatation. Ultimately, this results in relative and absolute hypovolemia, organ hypoperfusion, and septic shock. If shock persists, the result is progressive multiple organ failure and high mortality.
Fluid resuscitation has long been a fundamental component in the management of septic patients and choice of fluid has been a standing issue of debate for over half a century. The fact that human albumin solution appears to be beneficial for certain patient groups prompts the question of whether its use would confer a survival advantage in patients with sepsis.
The use of hydroxyethylstarch of molecular weight 130 kDa and substitution ratios 0.4 have been claimed to be safer than older generations, but the data to support this was insufficient and studies results have been inconclusive about the benefits and harms of this colloid compared with other fluids.
So, this study was designed to assess the effects of hydroxyethylstarch 6% 130/0.4 versus saline 0.9% or human albumin 4% on all cause mortality, kidney injury, length of ICU stay and organ failure defined by SOFA score. It included 165 patients with severe sepsis divided into 3 groups met the ACCP/SCCM criteria and after taking informed consent.
The study failed in proving any statistically significant benefit regarding mortality rate, rate of use of hemodynamic support, mechanical ventilation, or need of renal replacement therapy with any fluid intervention.
Although there was a trend towards decrease mortality in albumin group (32.7%) but not statistically proven, moreover there was also a trend towards increase in renal replacement therapy in HES 6% group (41.8%) again not statistically proven.
Use of H albumin 4% should be considered in resuscitation of severe sepsis patients. However, the routine administration of albumin to septic patients is difficult to justify on the basis of current knowledge and as we failed to prove any benefit other than lower volume of fluid used.
Use of saline is not inferior to colloids in resuscitation of severe sepsis patients and presents a cheap and effective alternative to colloids.
Use of HES 6% should be discouraged as it offers no benefit, it may inflect harm to renal function, nevertheless increase length of ICU stay and to prove this we are in need for future studies.