Saline Solution Versus Voluven®: A Controlled Study of Fluid Resuscitation in Severe Sepsis
Saline Solution Versus Voluven®: A Controlled Study of Fluid Resuscitation in Severe Sepsis
Fluid resuscitation of severe sepsis may consist of natural or artificial colloids or
 crystalloids. There is no evidence-based support for one type of fluid over another.

 The investigators hypothesis is that fluid resuscitation with Voluven® is advantageous to
 normal saline solution to improve sublingual microcirculation.
Shock is the failure of circulatory system to maintain adequate cellular perfusion. Septic
 shock is primarily a form of distributive shock and is characterized by ineffective tissue
 oxygen delivery and extraction associated with inappropriate peripheral vasodilation despite
 preserved or increased cardiac output. In sepsis, a complex interaction between pathologic
 vasodilation, relative and absolute hypovolemia, myocardial dysfunction, and altered blood
 flow distribution occurs due to the inflammatory response to infection. Even after the
 restoration of intravascular volume, microcirculatory abnormalities may persist and lead to
 maldistribution of cardiac output.

 Notwithstanding the complexity of its pathophysiology and treatment, to maintain adequate
 organ perfusion is a main goal in the management of severe sepsis and septic shock. For this
 purpose, optimization of intravascular volume and preload is the more important step. Fluid
 challenge is a term used to describe the initial volume expansion period in which the
 response of the patient to fluid administration is carefully evaluated. During this process,
 large amounts of fluids may be administered over a short period of time under close
 monitoring to evaluate the patient's response and avoid the development of pulmonary edema.
 Fluid challenge should be given in all patients suspected of hypovolemia. Fluid resuscitation
 may consist of natural or artificial colloids or crystalloids. There is no evidence-based
 support for one type of fluid over another. As the volume of distribution is much larger for
 crystalloids than for colloids, resuscitation with crystalloids requires more fluid to
 achieve the same end points and might result in more edema. In addition, post-hoc analysis
 and experimental studies suggest that colloids might be superior to crystalloids, in terms of
 physiologic end-points, recruitment of the microcirculation and mortality.
Inclusion Criteria:

 -  Severe sepsis

 Exclusion Criteria:

 -  Age of less than 18 years

 -  Pregnancy, or the presence of an acute cerebral vascular event, acute coronary
 syndrome, acute pulmonary edema, status asthmatics

 -  Cardiac dysrhythmias (as a primary diagnosis), contraindication to central venous
 catheterization, active gastrointestinal hemorrhage, seizure

 -  Drug overdose, burn injury, trauma, a requirement for immediate surgery, uncured
 cancer (during chemotherapy

 -  Immunosuppression (because of organ transplantation or systemic disease),
 do-not-resuscitate status, advanced directives restricting implementation of the
 protocol

 -  Delayed admission to ICU from emergency department (more than 4 hours), or fluid
 resuscitation previous to ICU with more than 1,500 cc