Early fluid replacement with hypertonic isoncotic solution guided by mixed venous oxygen saturation in experimental hypodynamic sepsis

Introduction

Volume replacement is one of the cornerstones in the management of sepsis. The type and amount of fluid are still controversial.

Hypothesis

A hypertonic isoncotic solution could promote superior hemodynamic benefits as the initial fluid regimen than standard crystalloid resuscitation, and mixed venous oxygen saturation could be useful to guide fluid administration in experimental sepsis.

Methods

Anesthetized mongrel dogs received an intravenous infusion of 1.2 × 10¹⁰ cfu/kg live E. coli in 30 minutes (T0–T30). After 60 minutes (T90), the dogs were randomized to receive isotonic saline solution, 32 ml/kg over 20 minutes (NS, n = 7) or 7.5% hypertonic isoncotic solution (Hyper-Haes) 4 ml/kg over 5 minutes (HH, n = 7). After 30 and 60 minutes (T120 and T150), additional isotonic saline solution 32 ml/kg was administered if mixed venous oxygen saturation was below 70% in both groups. the mean arterial pressure (MAP), cardiac output (CO) and portal blood flow (PVBF) were monitored; blood gases and lactate levels were analyzed at each timepoint.

Results

See Table 1. Data are expressed as the mean ± SEM.

Table 1

Conclusion

Both solutions promoted similar and partial benefits at systemic and regional levels in this hypodynamic sepsis model. Although initial fluid requirement after HH was lower than NS, overall fluid infused was not statistically different between groups (HH 31.4 ± 10.9 ml/kg vs NS 50.3 ± 6.5 ml/kg).