This multicenter, parallel-group, double-blind trial compared the effects of a balanced potato-derived tetrastarch solution (HES 130/0.42) and a balanced crystalloid solution (Ringer’s acetate) on 90-day mortality in patients with severe sepsis or septic shock. The authors report a significantly higher mortality rate in patients resuscitated with the tetrastarch solution. Surprisingly, 28-day mortality was not different between the two groups. This observation on mortality, the fact that the amount of fluid required to resuscitate patients was similar in both groups, and other information provided in the article raise more questions than they provide answers regarding the choice of the optimal fluid resuscitation regimen in this high-risk population. The results of this study are in contrast with those of the recently published CRYSTMAS trial (Guidet B et al, Crit Care 2012;16:R94). The debate regarding the potential deleterious effect of starches in septic patients will probably be solved in a near future with the publication of the results of the CHEST trial, which enrolled 7,000 critically ill patients including approximately 2,000 patients with sepsis.

– Philippe Van der Linden