VOLUME THERAPY IN THE CRITICALLY ILL - IS THERE A DIFFERENCE

Objective-There are still several concerns about the extensive and pro longed use of hydroxyethylstarch solution (HES) in critically ill pati ents, The effects of volume replacement with HES over 5 days on hemody namics, laboratory data, and organ function were compared with volume therapy using human albumin (HA). Design: Prospective, randomized stud y. Setting: Clinical investigations on a surgical intensive care unit (ICU) of a university hospital. Patients: 150 traumatized patients (in jury severity score > 15) and 150 postoperative patients with sepsis w ere analyzed. Interventions: Either 10% low-molecular weight HES (HES- trauma, n = 75: HES-sepsis, n = 75) or 20 % HA (HA-trauma, n = 75; HA- sepsis, n = 75) was given for 5 days to maintain the pulmonary capilla ry wedge pressure (PCWP) between 12 and 15 torr. The entire management of therapy of the patients was performed by physicians who were not i nvolved in the study and blinded to the infusion regimen. Measurements and results: In addition to extensive cardiorespiratory monitoring, s everal routine laboratory parameters for assessing pulmonary renal, he patic, and coagulation function were analyzed from arterial blood samp les on the day of admission to the ICU and on the day of sepsis diagno sis, respectively (''baseline'' value) and daily over the following 5 days, Mortality during and after the study did not differ significantl y between the infusion groups. There were also no differences between the incidence of pulmonary, renal, or hepatic failure in the two subgr oups, Mean arterial pressure, heart rate, and PCWP were similar in bot h subgroups, whereas cardiac index, oxygen delivery index, oxygen cons umption index, and the ratio between the partial pressure of oxygen in arterial blood and fractional inspired oxygen were higher in the HES- than in the HA-treated groups. Standard coagulation parameters did no t differ, albumin concentration increased significantly in both HA gro ups, and lactate concentrations decreased only in the HES-sepsis patie nts (from 2.8 +/- 0.5 to 1.5 +/- 0.4 mg/dl). Volume replacement using albumin was significantly (p < 0.001) more costly than therapy with HE S. Conclusions: Volume therapy with 10 % HES for 5 days in the ICU pat ient showed no disadvantages compared with an infusion regimen using 2 0 % albumin. Volume replacement using HES may even be associated with improved hemodynamics. HES appears to be a valuable and significantly cheaper alternative to albumin - even for prolonged volume therapy in the critically ill patient.