***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: UNLABELLED The effects of intravascular volume replacement regimens on tissue oxygen tension ( ptiO(2 ) ) are not definitely known . Forty-two consecutive patients scheduled for elective major abdominal surgery were prospect ively r and omized to receive either 6 % hydroxyethyl starch ( HES ) ( mean molecular weight 130 kd , degree of substitution 0.4 , n = 21 ) or lactated Ringer 's solution ( RL , n = 21 ) for intravascular volume replacement . Fluids were administered perioperatively and continued for 24 h on the intensive care unit to keep central venous pressure between 8 and 12 mm Hg . The ptiO(2 ) was measured continuously in the left deltoid muscle by using microsensoric implantable partial pressure of oxygen catheters after the induction of anesthesia ( baseline , T0 ) , 60 min ( T1 ) and 120 min thereafter ( T2 ) , at the end of surgery ( T3 ) , and on the morning of the first postoperative day on the intensive care unit ( T4 ) . HES 130/0.4 2920 + /- 360 mL and 11,740 + /- 2,630 mL of RL were given to the patients within the study period . Systemic hemodynamics and oxygenation ( PaO(2 ) , PaCO(2 ) ) did not differ significantly between the two volume groups throughout the study . From similar baseline values , ptiO(2 ) increased significantly in the HES-treated patients ( a maximum of 59 % at T4 ) , whereas it decreased in the RL group ( a maximum of -23 % at T4 , P < 0.05 ) . The largest differences of ptiO(2 ) were measured on the morning of the first postoperative day . We conclude that intravascular volume replacement with 6 % HES 130/0.4 improved tissue oxygenation during and after major surgical procedures compared with a crystalloid-based volume replacement strategy . Improved microperfusion and less endothelial swelling may be responsible for the increase in ptiO(2 ) in the HES 130/0.4-treated patients . IMPLICATION S In patients undergoing major abdominal surgery , a colloid-based ( with hydroxyethyl starch [ HES ] 130/0.4 ) and a crystalloid-based ( with lactated Ringer 's solution [ RL ] ) volume replacement regimen was compared regarding tissue oxygen tension ( ptiO(2 ) ) measured continuously by microsensoric implantable catheters . The ptiO(2 ) increased in the HES-treated ( + 59 % ) but decreased in the RL-treated ( -23 % ) patients . Improved microcirculation may be the mechanism for the better ptiO(2 ) in the HES group Objective Both albumin and synthetic colloids such as hydroxyethyl starch ( HES ) solution are used to optimize hemodynamics in the critically ill . The influence of different long-term infusion regimes on platelet function was studied . Design Prospect i ve , r and omized study . Setting Clinical investigation on a university hospital surgical intensive care unit . Patients Twenty-eight consecutive trauma patients ( injury severity score>15 points ) and 28 consecutive nontraumatized surgical patients with sepsis . Interventions The patients received either 20 % human albumin ( HA trauma , n=14 ; HA sepsis , n=14 ) or 10 % low-molecular-weight HES solution HES 200/0.5 ( HES trauma , n=14 ; HES sepsis;n=14 ) for 5 days to maintain central venous pressure and /or pulmonary capillary wedge pressure between 12 and 16 mmHg . Measurements and results Platelet function was assessed by aggregometry ( = turbidimetric technique ) using adenosine diphosphate 2.0 μmol/l , collagen 4 μl/ml , and epinephrine 25 μmol/l as inductors . Arterial blood was sample d on the day of admission or the day of diagnosis of sepsis ( = baseline value ) and over the next 5 days . St and ard coagulation parameters ( antithrombin III , fibrinogen , partial thromboplastin time ) were also measured . Total use of HES by the 5th day totalled 4870±990 ml in the trauma and 3260±790 ml in the sepsis patients ( HA trauma : 1850±380 ml ; HA sepsis : 1790±400 ml ) . Maximum platelet aggregation decreased significantly during the first 2–3 days after baseline in all groups . At the end of the investigation period , platelet aggregation variables had recovered and reached ( or even exceeded ) baseline values . Within the entire investigation period , the course of platelet aggregation variables did not differ significantly between HA and HES-treated patients irrespective of whether they were trauma or sepsis patients . Conclusions Alterations in hemostasis may occur for several reasons in the critically ill . Human albumin is the preferred first-line volume therapy in patients at risk for coagulation disorders . With respect to platelet function , volume replacement with ( lower-priced ) low-molecular-weight HES solutions can be recommended in this situation without any risk BACKGROUND It remains uncertain whether the choice of resuscitation fluid for patients in intensive care units ( ICUs ) affects survival . We conducted a multicenter , r and omized , double-blind trial to compare the effect of fluid resuscitation with albumin or saline on mortality in a heterogeneous population of patients in the ICU . METHODS We r and omly assigned patients who had been admitted to the ICU to receive either 4 percent albumin or normal saline for intravascular-fluid resuscitation during the next 28 days . The primary outcome measure was death from any cause during the 28-day period after r and omization . RESULTS Of the 6997 patients who underwent r and omization , 3497 were assigned to receive albumin and 3500 to receive saline ;  the two groups had similar baseline characteristics . There were 726 deaths in the albumin group , as compared with 729 deaths in the saline group ( relative risk of death , 0.99 ; 95 percent confidence interval , 0.91 to 1.09 ; P=0.87 ) . The proportion of patients with new single-organ and multiple-organ failure was similar in the two groups ( P=0.85 ) . There were no significant differences between the groups in the mean ( + /-SD ) numbers of days spent in the ICU ( 6.5+/-6.6 in the albumin group and 6.2+/-6.2 in the saline group , P=0.44 ) , days spent in the hospital ( 15.3+/-9.6 and 15.6+/-9.6 , respectively ; P=0.30 ) , days of mechanical ventilation ( 4.5+/-6.1 and 4.3+/-5.7 , respectively ; P=0.74 ) , or days of renal-replacement therapy ( 0.5+/-2.3 and 0.4+/-2.0 , respectively ; P=0.41 ) . CONCLUSIONS In patients in the ICU , use of either 4 percent albumin or normal saline for fluid resuscitation results in similar outcomes at 28 days BACKGROUND The role of intensive insulin therapy in patients with severe sepsis is uncertain . Fluid resuscitation improves survival among patients with septic shock , but evidence is lacking to support the choice of either crystalloids or colloids . METHODS In a multicenter , two-by-two factorial trial , we r and omly assigned patients with severe sepsis to receive either intensive insulin therapy to maintain euglycemia or conventional insulin therapy and either 10 % pentastarch , a low-molecular-weight hydroxyethyl starch ( HES 200/0.5 ) , or modified Ringer 's lactate for fluid resuscitation . The rate of death at 28 days and the mean score for organ failure were co primary end points . RESULTS The trial was stopped early for safety reasons . Among 537 patients who could be evaluated , the mean morning blood glucose level was lower in the intensive-therapy group ( 112 mg per deciliter [ 6.2 mmol per liter ] ) than in the conventional-therapy group ( 151 mg per deciliter [ 8.4 mmol per liter ] , P<0.001 ) . However , at 28 days , there was no significant difference between the two groups in the rate of death or the mean score for organ failure . The rate of severe hypoglycemia ( glucose level , < or = 40 mg per deciliter [ 2.2 mmol per liter ] ) was higher in the intensive-therapy group than in the conventional-therapy group ( 17.0 % vs. 4.1 % , P<0.001 ) , as was the rate of serious adverse events ( 10.9 % vs. 5.2 % , P=0.01 ) . HES therapy was associated with higher rates of acute renal failure and renal-replacement therapy than was Ringer 's lactate . CONCLUSIONS The use of intensive insulin therapy placed critically ill patients with sepsis at increased risk for serious adverse events related to hypoglycemia . As used in this study , HES was harmful , and its toxicity increased with accumulating doses . ( Clinical Trials.gov number , NCT00135473 . Objective There is continuing concern on the influence of hydroxethyl starch ( HES ) on renal function . Design Prospect i ve , r and omized study . Setting University-affiliated medical center . Patients Forty consecutive patients aged > 70 years undergoing cardiac surgery using cardiopulmonary bypass . Interventions Either low-molecular HES ( mean molecular weight : 130 kD ) with low degree of substitution ( 0.4 ) ( 6 % HES 130/0.4 ) ( n=20 ) or gelatin ( n=20 ) was given after induction of anesthesia until the 2nd postoperative day ( POD ) to keep central venous pressure between 12–14 mmHg . Measurements and results Creatinine clearance ( CC ) and fractional sodium clearance ( FSC ) were measured . N-acetyl-beta-D-glucosamidase , alpha-1-microglobulin , glutathione transferase-pi , and glutathione transferase-alpha were measured from urine specimens . Measurements were made after induction of anesthesia , at the end of surgery , and at the first and the second POD . More gelatin ( total : 4150±490 ml ) than HES 130/0.4 ( total : 3450±450 ml ) was infused within the study . CC and FSC were without differences between the two groups . All measured kidney-specific proteins were almost within normal range at baseline . They increased significantly after surgery , however , without significant group differences . At the 2nd POD , kidney-specific proteins had returned almost to normal values . None of the patients developed acute renal failure . Conclusions Sensitive markers of kidney dysfunction increased in our elderly patients indicating moderate alterations in kidney integrity during cardiac surgery . The two volume replacement regimens did not differ with regard to kidney integrity in elderly patients undergoing cardiac surgery Various vasoactive substances are involved in the regulation of the macro- and microcirculation . We have investigated if these regulators change during long-term volume therapy with human albumin ( HA ) or hydroxyethylstarch solution ( HES ) in trauma and sepsis patients . To maintain pulmonary capillary wedge pressure ( PCWP ) at 10 - 15 mm Hg , either 20 % HA ( HA-trauma , n = 14 ; HA-sepsis , n = 14 ) or 10 % low-molecular weight HES solution ( HES-trauma , n = 14 ; HES-sepsis , n = 14 ) were infused for 5 days , otherwise patient management did not differ between the two groups ( trauma/sepsis ) . Mean arterial pressure ( MAP ) , heart rate ( HR ) , PCWP and cardiac index ( CI ) were monitored in all patients .  Liver function was assessed using the monoethylglycinexylidide ( MEGX ) test , and gastric intramucosal pH ( pHi ) was monitored by tonometry to assess splanchnic perfusion . Plasma concentrations of vasopressin , endothelin-1 , adrenaline , noradrenaline , atrial natriuretic peptide and 6-keto-prostagl and in F1 alpha were measured from arterial blood sample s. All measurements were carried out on the day of admission to the intensive care unit ( trauma patients ) or on diagnosis of sepsis , and daily over the next 5 days at 12:00 . MAP , HR and PCWP did not differ between the corresponding subgroups ( trauma/sepsis ) . Cl increased significantly more in the HES than in the HA groups . pHi and MEGX plasma concentrations did not differ in the trauma patients throughout the study . Both were lower than normal in the sepsis groups and increased more markedly in the HES than in the albumin-treated patients ( P < 0.05 ) . In the trauma patients , concentrations of all vasoactive regulators were very similar in both groups . In both sepsis groups , vasopressors ( vasopressin , endothelin-1 , noradrenaline and adrenaline ) were significantly increased above normal at baseline and decreased more markedly in HES than in HA patients . Concentrations of atrial natriuretic peptide increased only in the HA patients ( from 159 ( 
    Output:
    
A recent systematic review and meta analysis from the Canadian Critical Care Trials Group concluded that critically ill patients receiving HES  were more likely to receive renal replacement therapy , and identified a trend toward increased risk of death in association with HES for patients with severe sepsis .