Volume 11 Supplement 3

Fourth International Symposium on Intensive Care and Emergency Medicine for Latin America

Open Access

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

  • L Rahal1,
  • AG Garrido1,
  • RJ CruzJr1,
  • M Rocha e Silva1 and
  • LF Poli de Figueiredo1
Critical Care200711(Suppl 3):P10

https://doi.org/10.1186/cc5797

Published: 19 June 2007

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

 

T0

T30

T90

T120

T150

T270

MAP (mmHg)

      

   NS

102 ± 3.8

87 ± 5.4*

54 ± 7.3*

73 ± 9.5*

65 ± 10.2*

69 ± 15.7*

   HH

105 ± 5.2

87 ± 7.8*

54 ± 7.3*

63 ± 8.1*

66 ± 9.3*

56 ± 9.4*

CO (l/min)

      

   NS

2.1 ± 0.2

1.7 ± 0.1*

1.2 ± 0.2*,a,b

2.3 ± 0.3*

1.6 ± 0.2*,d

1.2 ± 0.2*

   HH

2.2 ± 0.1

1.5 ± 0.1*

1.1 ± 0.1*,a,b

1.5 ± 0.2*

1.5 ± 0.2*

0.8 ± 0.1*

PVBF (ml/min)

      

   NS

510 ± 91

324 ± 60

160 ± 44*,a

396 ± 85

275 ± 72*

167± 53*

   HH

561 ± 32

287 ± 31*

218 ± 39*

233 ± 47*

204 ± 29*

129 ± 29*

SpO2 (%)

      

   NS

92 ± 1.2

86 ± 3.5

74 ± 4.6*

87 ± 3.2

79 ± 4.3

65 ± 6.9*

   HH

89 ± 1.8

81 ± 3.9

68 ± 2.4*

70 ± 4.2

70 ± 3.6d

52 ± 6.9*

P < 0.05 for the following comparisons: *vs baseline, aT90 vs T120, cT90 vs T270, cT120 vs T150, dT150 vs T270.

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).

Declarations

Acknowledgements

Supported by FAPESP 05/51176-5.

Authors’ Affiliations

(1)
LIM 11, InCor, University of São Paulo School of Medicine

Copyright

© BioMed Central Ltd 2007

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