Based on the Surviving Sepsis Campaign [3], ten recommendations were implemented in 15 ICUs of the Southern French ‘Languedoc Roussillon’ region. This before-after study resulted in a 28 day-mortality reduction. This finding was concordant better with those of recent, large studies [28-32].In the first 24 hours of management, more than 80% of the patients received HES. The volume of colloids was 830 �� 731 ml with a third quartile at 1,800 ml. The use of comparable volumes of HES in patients with severe sepsis or septic shock has already been reported elsewhere [19,33]. In the present study, the volume of infused HES was in the range of recommended doses, as only 2% of patients received more than 50 ml/Kg of HES. Our findings are globally consistent with the available literature, suggesting that our population is well-representative of severe sepsis and septic shock patients.

Of note, the total volume during the initial period of severe sepsis and or septic shock was lower than that reported by other groups [29,34]. The occurrence of renal dysfunction and the need for RRT are associated with poorer outcomes, as previously reported [1,2,35].In the Sepsi d’Oc study, the interventional period was associated with a larger occurrence of renal dysfunction but a higher 28-day survival rate. This finding suggests that an optimization of the initial management of patients with severe sepsis and septic shock may decrease the impact of renal dysfunction on the outcomes, as recently suggested by Badin et al.[36]. Moreover, the decrease in the 28-day mortality rate could expose more patients to the risk of renal dysfunction.

The present study failed to show that a low molecular weight HES is associated with poor renal outcomes. Initially, the potential deleterious effect of HES was demonstrated in the renal graft setting with previous non-low molecular weight types of HES [37,38]. The suggested mechanism was an osmotic nephrosis. In ICU patients with septic shock, Schortgen et al.[39] also reported that more renal dysfunction was predominant in patients receiving HES, but this did not result in an increase in mortality or the need for RRT. In the VISEP study [15], a higher rate of renal dysfunction was reported but this did not impact the 90-day mortality rate. These previous studies used high molecular weight HES that were sometimes given in extremely large doses.

Some studies have shown that HES 130/0.4 is not associated with the development of impaired renal function [18,19]. In the renal graft setting, two studies have shown that HES 130/0.4 is less deleterious in terms of renal function than the old generations of HES and gelatins [20,21]. Elsewhere, in ICU patients, three studies reported AV-951 that HES 130/0.4 administration was associated with poor renal outcome [8,22,40].