HES was widely used in patients with severe sepsis and septic shock in the initial 24-hour period but was not associated with deleterious impacts on renal function.Key messages? During the first 24 hours of severe sepsis or septic shock, 379 (98%) of 388 patients received fluid administration consisting exclusively of selleck chemicals Dasatinib HES 130/0.4 (n = 39 (10%)) or crystalloids (n = 63 (17%)), or both HES 130/0.4 and crystalloids (n = 276 (73%)). The mean total amount of fluid given during the first 24 hours was 3,780 �� 2,487 ml. The overall mortality rate was 32%.? RRT was required in 90 (23%) of 388 patients. The need for vasopressors and the baseline value of plasma creatinine were independently associated with the need for RRT. The mortality rates were 52% in patients requiring RRT and 26% in those not requiring RRT (P < 0.

01).? A renal dysfunction was diagnosed in 117 of 364 patients (32%) (34 patients were excluded because of missing information concerning the initial course of plasma creatinine). After multivariate analysis, male gender, an increase in SAPS II scores, surgical patients, no decrease in SOFA scores during the first 24 hours and the interventional period of the Sepsi d’Oc study were independently associated with renal dysfunction. The mortality rate was higher in patients with renal dysfunction than in those without renal dysfunction (48% versus 24%, P < 0.01).? The use of HES was not associated with RRT or renal dysfunction.

AbbreviationsAKIN: acute kidney injury network; ARF: acute renal failure; BMI: body mass index; HES: hydroxyethyl starch; ODIN: organ dysfunction and/or infection; RRT: renal replacement therapy; SAPS II: simplified acute physiology score II; SOFA: sequential organ dysfunction scoreCompeting interestsThe authors declare that they have no competing interests.Authors’ contributionsLM, SJ, NM and JYL designed the study. LM, SJ, SA, NM and JYL participated in the statistical analysis. LM, SJ, NM, ML, CS and JYL wrote the manuscript. ML, BA, JMC helped to review the final version of the manuscript. All authors participated in the enrollment of patients and in the acquisition of data. All authors have read and approved the final manuscript.AcknowledgementsThe authors thank the medical and nursing staffs of each unit participating to the study.

In intensive care unit (ICU) settings, several studies have long shown that physical examination was inaccurate in predicting the hemodynamic status of patients with circulatory or respiratory failure, Anacetrapib even when performed by experienced intensivists [1,2]. Specifically, the range of cardiac index (low, normal or high) has been shown to be adequately predicted by the physical examination in only 44 to 51% of ICU patients who were evaluated using right heart catheterization [1-3].