Objective ‒ to compare the hemodynamic effects and safety of the infusion of succinylated gelatin solution, sorbitol-containing solution, and 0.9 % normal saline (0.9 % sodium chloride), analyze their effect on the treatment of septic shock and mortality.Materials and methods. A prospective randomized clinical trial that included 94 adult patients with an active surgical infection and septic shock was conducted. There were 34 (36.2 %) male and 60 (63.8 %) female patients aged between 19 and 96 years, mean age was (66.51 ± 17.06) years. An appropriate solution in a volume of 500 ml was used for resuscitation, then hemodynamic and other clinical and laboratory parameters were monitored.Results. There was no significant difference in mean arterial pressure (MAP) between the 3 groups until the 40th minute (p>0.05). At the 45th minute MAP in the NS group differed only from MAP in the Gel group (p=0.007). At the 50th minute MAP in the NS group did not differ from the baseline (p=0.139). From the 50th minute to 2 hours, MAP in the Gel and Sorb groups was higher than in the NS group in all measurements (p<0.05). There was no statistically significant difference in heart rate (HR) in any measurement (p>0.05). Cardiac output (CO) did not differ up to the 30th minute (p>0.05), at the 35th minute, CO differed only between Gel and NS groups (p=0.019), from the 40th minute to 2 hour CO in Gel and Sorb groups were significantly higher than in NS group in all measurements (p<0.05). Oxygen delivery (DO2) also did not differ up to the 30th minute (p>0.05), from the 35th minute to the 45th minute a significant difference was found only between Gel and NS groups (p<0.05), from the 50th minute to 2 hour DO2 in Gel and Sorb group was significantly higher than in NS group in all measurements (p<0.05). After infusion of the gelatin-containing solution and sorbitol-containing solution, the acid-base balance of the blood improved significantly. The dose of gelatin-containing and sorbitol-containing solutions applied in this study was safe for the renal function of the patients with septic shock. However, it is possible that a decrease in blood fibrinogen concentrations may be associated with the use of a gelatin-containing solution. Significant improvement in the Glasgow Coma Scale scores was observed only in patients in the group receiving the sorbitol-containing solution. The difference in 28-day mortality between the groups was not statistically significant (p=0.993).Conclusions. In our observations, when using these three types of solution in patients with septic shock, hemodynamic effects up to the 40th minute did not differ between groups. From the 40th minute to 2 hour, the volemic effect of 4 % succinylated gelatin solution and balanced polyionic solution with 6 % sorbitol was significantly better, compared to the 0.9 % sodium chloride solution. The volume of solutions used in these three groups did not affect renal function in patients with septic shock. The amount of balanced polyionic solution used with 6 % sorbitol and 0.9 % sodium chloride solution did not affect blood coagulation function. But the use of 4 % succinyl gelatin solution reduced the concentration of fibrinogen in the blood. After infusion of the gelatin-containing solution with buffer formulations and sorbitol-containing solution with buffer formulations, the acid-base status of the blood was significantly improved compared to 0.9 % sodium chloride solution. Infusion of the gelatin-containing solution and 0.9 % sodium chloride solution did not affect the Glasgow coma score in patients. After infusion of the sorbitol-containing solution, patients’ consciousness was improved by this scale. The 28-day mortality did not differ significantly between groups.

Authors' contribution Wkład autorów:A. Study design/planning zaplanowanie badań B. Data collection/entry zebranie danych C. Data analysis/statistics dane -analiza i statystyki D. Data interpretation interpretacja danych E. Preparation of manuscript przygotowanie artykułu F. Literature analysis/search wyszukiwanie i analiza literatury G. Funds collection zebranie funduszy Summary Background. Infusion therapy is the primary stage of resuscitation in patients with septic shock. But excess fluids may cause adverse outcomes, so which indicators should doctors monitor to predict whether the infusion volume is sufficient? Material and methods. The prospective clinical study included 68 consecutive intensive care unit (ICU) adult patients with septic shock, who had an active surgical infection. Minimally invasive methods were used to continuously record cardiac output (CO). In this study, we compare the passive leg raise (PLR) test and initial central venous oxygen saturation (ScvO 2 ) levels in terms of correlation with, and predictive accuracy for, infusion response. Results. The predictive accuracy of PLR testing and initial ScvO 2 levels for infusion response was 55.9% vs. 67.6% in septic shock patients with abdominal infection. Results from the PLR test and reaction to infusion therapy revealed a slight positive correlation (R=0.239, P=0.018), initial ScvO 2 and reaction to infusion therapy revealed a moderate negative correlation (R=-0.305, P=0.009). Conclusions. In intra-abdominal septic shock patients, the PLR test is not a reliable predictor of response to infusion, but low initial ScvO 2 levels can be used for the prediction of response to infusion. Administering a fluid challenge with dynamic indicators (such as CO) is the most accurate method for clinicians to determine the need for further infusion therapy.

The aim. Compare the hemodynamic effects and safety of infusion of the balanced crystalloid solution, sorbitol-based solution, and standard solution (0.9 % sodium chloride). Materials and methods. A prospective randomized clinical trial was carried out, the study included 68 adult patients, who had the active surgical infection, and were in a state of septic shock. A corresponding solution with a volume of 500 ml was used for resuscitation. Hemodynamic and other clinical and laboratory parameters were monitored. Results. There was no significant difference in mean arterial pressure (MAP) between the 3 groups before the 45th minute (p>0.05), from the 50th minute to 2 hours they were found only between the NS and Sorb groups (p <0.05). No statistically significant difference in heart rate (HR) was obtained in any measurement (p> 0.05). Cardiac output (CO) and oxygen delivery (DO2) did not differ until 35 min (p> 0.05) and up to 40 min (p> 0.05); after 40 min and 45 min, a significant difference was also found between the Sorb and NS groups (p <0.05). After infusion of a sorbitol-containing solution and a balanced polyionic solution, the acid-base state of the blood significantly improved. The applied dose of the sorbitol-containing solution was safe for renal function and blood clotting in septic shock in this study. But the applied balanced polyionic solution may be associated with a decrease in the number of platelets. Daily changes by APACHE II scores in each group were not statistically significant. The difference in 7-day and 28-day mortality between groups was not statistically significant (p>0.05). Conclusions. In our study, the balanced polyionic solution with 1.9 % sodium lactate and 6 % sorbitol was the most effective and safe infusion solution for the treatment of septic shock, it can be used as a supplement to balanced crystalloid solutions. When using a balanced polyionic solution (Ringer's acetate) with 0.07 % L-malonic acid, the platelet count should be monitored more often

The initial lactate level has been used as one of mortality predictors in patients with septic shock. Different studies measured the concentrations of blood lactate obtained from different vessels. Even in some retrospective studies, blood lactate levels from heterogeneous sources (artery, central vein, and peripheral vein) have been used. Practicing physicians face following questions: what data have the best predictive value, can they replace each other? In our observations, а high positive linear correlation was found between lactate concentrations in arterial and central venous blood (R = 0.895; P < 0.001). Both indicators have satisfactory values for predicting treatment outcome. Lactate level in arterial blood had a slightly better predictive value compared to its concentration in central venous blood.