[Study protocol of the VISEP study. Response of the SepNet study group]

Area of Science:

• Critical care medicine
• Pharmacology
• Clinical research

Background:

• A sepsis trial evaluated hydroxyethyl starch (HES) and insulin therapy.
• Concerns were raised regarding study methodology and drug actions.
• The commentary by Zander et al. was based on potentially inaccurate assumptions.

Discussion:

• The study clarifies that HES was not used for exclusive fluid maintenance.
• The manufacturer's guidelines for the HES product (Hemohes) do not specify a creatinine cut-off.
• Claims regarding lactated solutions causing elevated lactate, hyperglycemia, and increased O2 consumption are unsubstantiated by the study or current guidelines.

Key Insights:

• The study's HES and insulin therapy approach in sepsis requires accurate interpretation of methodology.
• Published sepsis trial data refutes claims of exclusive HES use and specific creatinine cut-off manipulations.
• Evidence does not support the assertion that lactated solutions universally increase lactate, cause hyperglycemia, or elevate O2 consumption in sepsis.

Outlook:

• Open scientific debate is encouraged following peer-reviewed publication.
• Further critical review of the published sepsis trial data is welcomed.
• The authors advocate for unbiased scientific discourse, free from premature conclusions based on flawed assumptions.