Please select the eligibility criteria that correspond to the clinical trial below.
Title: Saline Solution Versus Voluven®: A Controlled Study of Fluid Resuscitation in Severe Sepsis
Brief Summary: 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.


Options:
A: Inclusion Criteria:

* Severe sepsis
* Requirement for fluid resuscitation

Exclusion Criteria:

* serum creatinine \> 300µmol/L
* Chronic renal failure
* Anuria lasting more than 4 hours
* Requirement for renal support
B: Inclusion Criteria:

* Patients with severe sepsis or septic shock, if each one of the following criteria is satisfied:

  * Proved or suspected infection in at least one site:

    * lung
    * abdomen
    * genito-urinary tract
    * other (blood, skin and soft tissue, central nervous system, bones and joints, cardiac system, catheter-related infection, other)
  * Two or more of the following:

    * a core temperature ≥ 38° C o ≤ 36° C
    * a heart rate ≥ 90 beats/min
    * a respiratory rate ≥ 20 breaths/min or PaCO2 ≤ 32 mmHg or use of mechanical ventilation for an acute process
    * a white blood cell count ≥ 12000/ml or ≤ 4000/ml or immature neutrophils \> 10%
  * Presence of at least a severe organ dysfunction, as measured by the modified Sequential Organ Failure Assessment (SOFA) score:

    * respiratory score \> 1
    * hematologic score \> 1
    * hepatic score \> 1
    * cardiovascular score equal to 1, 3 or 4
    * renal score \> 1

Exclusion Criteria:

* Age below 18 years
* Terminal state
* Known adverse reaction to albumin administration
* Severe sepsis or septic shock in patients after proved or suspected head injury, clinically active
* Congestive heart failure (NYHA score III and IV)
* Pathological conditions in which albumin administration is clinically indicated (hepatic cirrhosis with ascites, intestinal malabsorption syndrome, nephritic syndrome, burns)
* More than 24 hours since inclusion criteria were met
* Religious objection to the administration of human blood products
* Inclusion in other experimental study
C: Inclusion Criteria:

* Blunt or penetrating trauma
* Prehospital Systolic Blood Pressure (SBP) \<= 70;OR
* Prehospital SBP 71-90 AND Hear Rate (HR) ≥108
* 15 years of age or older, or 50kg or more if age unknown

Exclusion Criteria:

* Known or suspected pregnancy
* Age younger than 15 or less than 50kg if age unknown
* Ongoing prehospital cardiopulmonary resuscitation (CPR)
* Administration of more than 2000cc crystalloid or any colloid or blood products
* Severe hypothermia (suspected Temperature less than 28 degrees celsius)
* Drowning or asphyxia due to hanging
* Burns Total Body Surface Area (TBSA) more than 20%
* Isolated penetrating injury to the head
* Inability to obtain prehospital intravenous access
* Time of call received at dispatch to study intervention greater than four hours
* Known prisoners
D: 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

Answer: D