Intensive Care Med (2004) 30:1356–1360 DOI 10.1007/s00134-004-2278-5 ORIGINAL Zsolt Molnµr Andrµs Mikor Tamµs Leiner Tamµs Szakmµny Fluid resuscitation with colloids of different molecular weight in septic shock Received: 4 November 2003 Accepted: 9 March 2004 Published online: 4 May 2004  Springer-Verlag 2004 Electronic Supplementary Material Supplementary material is available in the online version of this article at http://dx.doi.org/10.1007/s00134-004-2278-5 Z. Molnµr ( ) ) · A. Mikor · T. Leiner · T. Szakmµny Department of Anaesthesiology and Intensive Care, University of PØcs, PØcs, Hungary e-mail: z_molnar@hotmail.com Tel.: +36-72-536440 Fax: +36-72-536441 Abstract Objective: The aim of this study was to investigate the short-term effect of fluid resuscita- tion with 4% modified fluid gela- tine (GEL) versus 6% hydroxyethyl starch (HES) on haemodynamics and oxygenation in patients with septic shock and acute lung injury (ALI). Design: Prospective random- ised clinical trial. Setting: Twenty- bed intensive care unit in a university hospital. Patients: Thirty hypovo- lemic patients (intrathoracic blood volume index, ITBVI <850 ml/m 2 ) in septic shock with ALI were ran- domised into HES (mean molecular weight: 200,000 Dalton, degree of substitution 0.6) and GEL (mean molecular weight: 30,000 Dalton) groups (15 patients each). Interventions: For fluid resuscita- tion 250 ml/15 min boluses (max. 1,000 ml) were given until the end point of ITBVI >900 ml/m 2 was reached. Repeated haemodynamic measurements were done at baseline (t b ), at the end point (t ep ) then at 30 min and 60 min after the end point was reached (t 30 ,t 60 ). Cardiac output, stroke volume, extravascular lung water (EVLW), and oxygen delivery was determined at each assessment point. For statistical analysis two-way ANOVA was used. Measurements and results: ITBVI, cardiac index, and oxygen delivery index increased significantly at t ep and remained ele- vated for t 30 and t 60 , but there was no significant difference between the two groups. The increase in the ITBVI by 100 ml of infusion was similar in both groups (HES: 26€ 19 ml/m 2 vs GEL: 30€19 ml/m 2 ). EVLW, remained unchanged, and there was no significant difference between the groups (HES, t b : 8€6, t 60 : 8€6; GEL, t b : 8€3, t 60 : 8€3 ml/ kg). The PaO 2 /FiO 2 did not change significantly over time or between groups (HES, t b : 207€114, t 60 : 189€78; GEL, t b : 182€85, t 60 : 182€85 mmHg). Conclusion: The results of this study indicate that both HES and GEL infusions caused similar short-term change in ITBVI in septic shock, without increasing EVLW or worsening oxygenation. Keywords Septic shock · Acute lung injury · Fluid resuscitation · Colloid · Extravascular lung water Introduction Hypovolemia is a common clinical occurrence in severe sepsis, and changes in cardiorespiratory physiology play a key role in outcome. Whilst adequate volume replacement therapy appears to be essential in this situation to maintain tissue perfusion and prevent multiple system organ failure (MSOF), it may also lead to interstitial fluid accumulation due to increased endothelial permeability [1, 2]. Excessive volume loading or increased capillary leakage may result in pulmonary oedema often referred to as extravascular lung water (EVLW). It seems reasonable that fluid man-