During three study periods, the authors compared the effects of the type of fluid resuscitation on the time to septic shock reversal and the development of acute kidney injury (AKI, defined by RIFLE criteria) and renal replacement therapy in septic surgical patients. They compared fluid therapy with hydroxyethyl starch (HES, n = 360), 4% gelatin (n = 352) and only crystalloids only (n = 334). Hospital length of stay, ICU and hospital mortality did not differ significantly between groups. All showed similar time to shock reversal (serum lactate < 2.2 mmol/L and discontinuation of vasopressor use). If more fluid was needed during the first 4 days in the crystalloid group (fluid ratios: 1.4 :1 vs. HES; 1.1:1 vs. gelatin), HES and gelatin were independent risk factors for AKI (odds ratios [95% CI]: 2.55 [1.76-3.69] and 1.85 [1.31-2.62]).

This study should be added to the other studies incriminating HES solutions as being associated with the development of AKI in ICU patients. However, the deleterious effect of gelatins is worrying and requires a prospective randomized study comparing them to crystalloids.

– Michael Piagnerelli