Types of Colloid Therapy in Critically Ill Patients

We appreciate Dr. Gallagher's comments on our article, which deals with different types of colloid therapy in critically ill patients. However, we disagree with Dr. Gallagher that the only reason for the differences between the groups results from the fact that filling volumes were larger in those patients treated with hydroxyethyl starch. Pulmonary capillary wedge pressure and central venous pressure (not shown in the article) were similar within both subgroups (trauma/sepsis). Right ventricular endiastolic volume index and right ventricular endsystolic volume index were also without difference in both trauma groups. Nevertheless, cardiac index, oxygen consumption index, and oxygen delivery index were significantly more increased in the hydroxyethylstarch solution (HES)-than in the human albumin-treated group. Only right ventricular endiastolic volume index was different between HES- and human albumin-treated sepsis patients. This was statistically different, but it is doubtful whether this difference was relevant (maximum difference between the two HES-treated sepsis groups = 14 ml/kg [approximately 8%-10% difference]). Thus, it seems likely to us that the beneficial effects of intravascular volume replacement with HES, which were commented on by an editorial in the same issue of Anesthesia & Analgesia, were due to different amounts of infusion volume. Joachim Boldt, MD Department of Anesthesiology and Intensive Care Medicine; Justus-Liebig-University Giessen; 35392 Giessen, Germany