Fluid Replacement With Hypertonic or Isotonic Solutions Guided by Mixed Venous Oxygen Saturation in Experimental Hypodynamic Sepsis

Rahal, Luciana; Garrido, Alejandra G.; Cruz, Ruy J.; Silva, Eliezer; Poli-de-Figueiredo, Luiz Francisco

doi:10.1097/ta.0b013e31818b2567

Cited by 15 publications

(10 citation statements)

References 31 publications

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“…Quite obviously, the plasma-expander effect of HSL might be related to its hyperosmolarity because a similar effect has been reported with hypertonic saline [17-19]. However, although HSL is hyperosmolar (see Table 1), it is less hypertonic than a sodium-chloride solution with the same osmolarity, because the monocarboxylate carrier allows lactate to cross the cellular plasma membrane [20].…”

Section: Discussionmentioning

confidence: 98%

Early resuscitation of dengue shock syndrome in children with hyperosmolar sodium-lactate: a randomized single-blind clinical trial of efficacy and safety

et al. 2014

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IntroductionDengue shock syndrome (DSS) fluid resuscitation by following the World Health Organization (WHO) guideline usually required large volumes of Ringer lactate (RL) that might induce secondary fluid overload. Our objective was to compare the effectiveness of the recommended volume of RL versus a smaller volume of a hypertonic sodium lactate solution (HSL) in children with DSS. The primary end point was to evaluate the effect of HSL on endothelial cell inflammation, assessed by soluble vascular cell adhesion molecule-1 (sVCAM-1) measurements. Secondarily, we considered the effectiveness of HSL in restoring hemodynamic fluid balance, acid–base status, and sodium and chloride balances, as well as in-hospital survival.MethodsA prospective randomized single-blind clinical trial including 50 DSS children was conducted in the Pediatrics Department of Hasan Sadikin Hospital, Bandung, Indonesia. Only pediatric patients (2 to 14 years old) fulfilling the WHO criteria for DSS and new to resuscitation treatments were eligible. Patients were resuscitated with either HSL (5 ml/kg/BW in 15 minutes followed by 1 ml/kg/BW/h for 12 hours), or RL (20 ml/kg/BW in 15 minutes followed by decreasing doses of 10, 7, 5, and 3 ml/kg BW/h for 12 hours).ResultsIn total, 50 patients were randomized and included in outcome and adverse-event analysis; 46 patients (8.2 ± 0.5 years; 24.9 ± 1.9 kg; mean ± SEM) completed the protocol and were fully analyzed (24 and 22 subjects in the HSL and RL groups, respectively). Baseline (prebolus) data were similar in both groups. Hemodynamic recovery, plasma expansion, clinical outcome, and survival rate were not significantly different in the two groups, whereas fluid accumulation was one third lower in the HSL than in the RL group. Moreover, HSL was responsible for a partial recovery from endothelial dysfunction, as indicated by the significant decrease in sVCAM-1.ConclusionSimilar hemodynamic shock recovery and plasma expansion were achieved in both groups despite much lower fluid intake and fluid accumulation in the HSL group.Trial RegistrationClinicalTrials.gov NCT00966628. Registered 26 August 2009.

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Section: Discussionmentioning

confidence: 98%

Early resuscitation of dengue shock syndrome in children with hyperosmolar sodium-lactate: a randomized single-blind clinical trial of efficacy and safety

et al. 2014

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“…Hypertonic fluid administration in a porcine model of acute hyperdynamic endotoxemia resulted in a persistently high oxygen delivery to splanchnic organs (30). In a more recent animal study, hypertonic fluid administration failed to restore splanchnic perfusion variables but reduced the degree of gut epithelial cells apoptosis (31).…”

Section: Discussionmentioning

confidence: 98%

Hypertonic Fluid Administration in Patients With Septic Shock

Haren

Sleigh

Boerma

et al. 2012

Shock

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We assessed the short-term effects of hypertonic fluid versus isotonic fluid administration in patients with septic shock. This was a double-blind, prospective randomized controlled trial in a 15-bed intensive care unit. Twenty-four patients with septic shock were randomized to receive 250 mL 7.2% NaCl/6% hydroxyethyl starch (HT group) or 500 mL 6% hydroxyethyl starch (IT group). Hemodynamic measurements included mean arterial blood pressure (MAP), central venous pressure, stroke volume index, stroke volume variation, intrathoracic blood volume index, gastric tonometry, and sublingual microcirculatory flow as assessed by sidestream dark field imaging. Systolic tissue Doppler imaging velocities of the medial mitral annulus were measured using echocardiography to assess left ventricular contractility. Log transformation of the ratio MAP divided by the norepinephrine infusion rate (log MAP/NE) quantified the combined effect on both parameters. Compared with the IT group, hypertonic solution treatment resulted in an improvement in log MAP/NE (P = 0.008), as well as an increase in systolic tissue Doppler imaging velocities (P = 0.03) and stroke volume index (P = 0.017). No differences between the groups were found for preload parameters (central venous pressure, stroke volume variation, intrathoracic blood volume index) or for afterload parameters (systemic vascular resistance index, MAP). Hypertonic solution treatment decreased the need for ongoing fluid resuscitation (P = 0.046). No differences between groups were observed regarding tonometry or the sublingual microvascular variables. In patients with septic shock, hypertonic fluid administration did not promote gastrointestinal mucosal perfusion or sublingual microcirculatory blood flow in comparison to isotonic fluid. Independent of changes in preload or afterload, hypertonic fluid administration improved the cardiac contractility and vascular tone compared with isotonic fluid. The need for ongoing fluid resuscitation was also reduced.

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“…The most consistent finding from large animal models of sepsis is that of a short-term improvement in cardiac output associated with fluid resuscitation, with the effect dissipating rapidly after the termination of infusion [72–74]. Similarly, a number of studies have demonstrated modest improvements in gastrointestinal perfusion with fluid resuscitation [73]; however, this finding is not consistent in all the animal studies [74].…”

Section: Preclinical Evidence For the Use Of Fluid Resuscitation In Smentioning

confidence: 99%

“…When challenged with intravenous endotoxin, humans also develop a hyperdynamic circulation [34]. This contrasts with the response seen in most large and small animal models, where hypodynamic shock after sepsis or endotoxemia predominates [72–74, 76–78, 82, 83]. These disparities occur from both the design characteristics of the models and the differences in human and experimental animal physiology.…”

Section: Preclinical Evidence For the Use Of Fluid Resuscitation In Smentioning

confidence: 99%

Fluid resuscitation in human sepsis: Time to rewrite history?

Byrne

Haren

2017

Ann. Intensive Care

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Fluid resuscitation continues to be recommended as the first-line resuscitative therapy for all patients with severe sepsis and septic shock. The current acceptance of the therapy is based in part on long history and familiarity with its use in the resuscitation of other forms of shock, as well as on an incomplete and incorrect understanding of the pathophysiology of sepsis. Recently, the safety of intravenous fluids in patients with sepsis has been called into question with both prospective and observational data suggesting improved outcomes with less fluid or no fluid. The current evidence for the continued use of fluid resuscitation for sepsis remains contentious with no prospective evidence demonstrating benefit to fluid resuscitation as a therapy in isolation. This article reviews the historical and physiological rationale for the introduction of fluid resuscitation as treatment for sepsis and highlights a number of significant concerns based on current experimental and clinical evidence. The research agenda should focus on the development of hyperdynamic animal sepsis models which more closely mimic human sepsis and on experimental and clinical studies designed to evaluate minimal or no fluid strategies in the resuscitation phase of sepsis.

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Fluid Replacement With Hypertonic or Isotonic Solutions Guided by Mixed Venous Oxygen Saturation in Experimental Hypodynamic Sepsis

Abstract: Although normalization of mixed venous oxygen saturation was not associated with restoration of markers of splanchnic or other systemic perfusion variables, the initial fluid savings with hypertonic saline and its latter effect on gut apoptosis may be of interest in sepsis management.

Cited by 15 publications

References 31 publications

Early resuscitation of dengue shock syndrome in children with hyperosmolar sodium-lactate: a randomized single-blind clinical trial of efficacy and safety

Early resuscitation of dengue shock syndrome in children with hyperosmolar sodium-lactate: a randomized single-blind clinical trial of efficacy and safety

Hypertonic Fluid Administration in Patients With Septic Shock

Fluid resuscitation in human sepsis: Time to rewrite history?

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