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Early fluid replacement with hypertonic isoncotic solution guided by mixed venous oxygen saturation in experimental hypodynamic sepsis
Critical Carevolume 11, Article number: P10 (2007)
Volume replacement is one of the cornerstones in the management of sepsis. The type and amount of fluid are still controversial.
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.
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.
See Table 1. Data are expressed as the mean ± SEM.
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).
Supported by FAPESP 05/51176-5.