Effects of hydroxyethyl starch in critically ill patients

Editor—The Sepsis Occurrence in Acutely ill Patients (SOAP)trial group have published another analysis from their database¹on hydroxyethyl starch (HES) and its effects on renal function.²However, we are concerned that the methods used were not adequate,and the conclusion drawn ‘that HES had no influence onrenal function or the need for renal replacement therapy (RRT)’must therefore be viewed with caution. Our main concerns areas follows.

1. Cohort studies must be planned in such a way thatavailabledata about potential confounding factors are of goodquality.To ensure this, outcome events must be clearly pre-specifiedin the protocol and the data which will be     

Studienprotokoll der VISEP-Studie

In the commentary by Zander et al. the authors appear concerned about the methods and results of our, at that time, unpublished sepsis trial evaluating hydroxyethyl starch (HES) and insulin therapy. Unfortunately, the authors' concerns are based on false assumptions about the design, conduct and modes of action of the compounds under investigation. For instance, in our study the HES solution was not used for maintenance of daily fluid requirements, so that the assumption of the authors that this colloid was used "exclusively" is wrong. Moreover, the manufacturer of Hemohes, the HES product we used, gives no cut-off value for creatinine, thus the assumption that this cut-off value was "doubled" in our study is also incorrect. Other claims by the authors such as that lactated solutions cause elevated lactate levels, iatrogenic hyperglycemia and increase O(2) consumption are unfounded. There is no randomized controlled trial supporting such a claim - this claim is neither consistent with our study data nor with any credible published sepsis guidelines or with routine practice worldwide. We fully support open scientific debate. Our study methods and results have now been published after a strict peer-reviewing process and this data is now open to critical and constructive reviewing. However, in our opinion this premature action based on wrong assumptions and containing comments by representatives of pharmaceutical companies does not contribute to a serious, unbiased scientific discourse.     

Procalcitonin und C3a: Nützlich zur Prognose- und Verlaufsbeurteilung der Sepsis?

Ohne Zusammenfassung     

Prävention und Nachsorge der Sepsis

The 1st revision of the S2k guideline on the prevention and follow-up care of sepsis, provided by the German Sepsis Society in collaboration with 17 German medical scientific societies and one self-help group provides state-of-the-art information on the effective and appropriate medical care of critically ill patients with severe sepsis or septic shock. The guideline recommendations may not be applied under all circumstances. It rests with the clinician to decide whether a certain recommendation should be adopted or not, taking into consideration the unique set of clinical facts presented in connection with each individual patient as well as the available resources.