[22], the baseline Central Venous Pressure (CVP) value was lower and more albumin and platelets and fresh frozen plasma were administrated in the HES group than selleck chem in the gelatin and crystalloids groups. Moreover, patients in the HES group were more exposed to nephrotoxic product. These differences could explain why more renal dysfunctions were observed in this group without an increase in the need for RRT. In the study reported by Shortgen et al.[40], patients requiring HES administration previously received larger amounts of fluids. Moreover, they required more mechanical ventilation suggesting that they were more seriously ill whereas the SAPS II score was similar. In contrast, other groups reported similar findings to those of the present study [18,19].

In the SOAP study [41], the infusion of HES was more frequent in the most seriously ill patients (higher baseline SAPS II and SOFA scores, more mechanically ventilated patients, more patients requiring blood products, more patients with severe sepsis and more patients with shock during their ICU stay) [18]. However, the multivariate analysis did not find that HES were associated with an increased risk of renal dysfunction. The study reported by Boussekey et al.[19] also failed to find a deleterious effect of HES in patients with severe sepsis and/or septic shock. Moreover, volumes of infused HES were similar to those reported in the present study (763 �� 595 ml on day 2, 1,031 �� 800 ml on day 7, 1,361 �� 1,393 ml on day 21). Our study suggests that in a real life situation, the physicians tend to respect the recommended doses of HES.

This could probably partly explain the different results with previous studies in which HES was widely given. The present study clearly shows that the use of adequate dosages of HES is not associated with the occurrence of renal dysfunction.The present study has several limitations. First, it focused on the use of different therapies in the first 24 hours of initial management of patients with severe sepsis and/or septic shock. We cannot report the real volume of fluid after 24 hours. However, Boussekey et al.[19] showed that the main dosage of HES is administrated in the first two days. Second, the present study was a cohort study and several biases could interfere with the findings. The physicians were not blinded, and a pre-selection of patients may have played a role in our results.

However, this is a study reporting real-life practice, giving a partial response to an unresolved issue. One should note that more than 70% of our patients received both Drug_discovery colloids and crystalloids, while randomized clinical trials often favor the use of a single type of fluid [15,39]. Even if a multivariate analysis was performed, further randomized clinical trials will probably provide a definitive answer.