title: High dosage of dextran 70 is associated with severe bleeding in patients admitted to the intensive care unit for septic shock.
abstract: BACKGROUND
  Synthetic colloids are frequently used in fluid resuscitation of septic patients. Despite this, little is known about the potential side effects including the risk of renal failure and bleeding. As practice has changed, we performed a before-and-after study of fluid resuscitation and outcome in patients with septic shock.
  
  
  METHODS
  We retrospectively assessed all adult patients with septic shock admitted to a general intensive care unit (ICU) at a tertiary hospital in the years 2006 and 2008. Data on patient characteristics, resuscitation fluids in the ICU and outcome were collected from electronic databases and patient files.
  
  
  RESULTS
  A total of 332 patients with septic shock were included: 171 in 2006 and 161 in 2008. The use of mainly dextran 70 in 2006 (median 3.5 (interquartile range 1.9-7.1) versus 1.5 (0.5-3.0) l, p < 0.0001; 44 (24-86) versus 18 (8-42) ml/kg, p < 0.0001) had changed to mainly crystalloids (Ringer's lactate 0 (0.0-0.3) versus 1.1 (0.0-3.0) l, p < 0.0001) and albumin (5%, 0.0 (0.0-1.0) versus 0.8 (0.0-1.5) l, p < 0.0001; 20%, 0.0 (0.0-0.3) versus 0.1 (0.0-0.4) l, p < 0.0001) in 2008. There were no differences in rates of renal replacement therapy or 90-day mortality, but more patients experienced severe bleeding in 2006 than in 2008 (30 versus 19%, p = 0.03). Also more red blood cells, plasma and platelets were given in 2006 than in 2008 (p < 0.01 for all).
  
  
  CONCLUSIONS
  In patients with septic shock, fluid treatment had changed from mainly dextran 70 in 2006 to crystalloids and albumin in 2008. The administration of high-dosage dextran 70 was associated with more patients experiencing severe bleeding.
  
  
  BACKGROUND
  not relevant.
  
  
  BACKGROUND
  not relevant.
authors.affiliation: Intensiv Terapiklinik, Abdominalcentret, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Lisa Nebelin
authors.initials: LN
authors.lastname: Hvidt
authors.forename: Anders
authors.initials: A
authors.lastname: Perner
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced / Q000453:epidemiology; D000328:Adult; D003102:Colloids / Q000008:administration & dosage / Q000009:adverse effects; D003718:Denmark; D003911:Dextrans / Q000008:administration & dosage / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D057286:Electronic Health Records; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D019999:Pharmaceutical Solutions / Q000008:administration & dosage / Q000009:adverse effects; D010952:Plasma Substitutes / Q000008:administration & dosage / Q000009:adverse effects; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000188:drug therapy*; D015996:Survival Rate
chemical_list: D003102:Colloids; D003911:Dextrans; D019999:Pharmaceutical Solutions; D010952:Plasma Substitutes